FORM - A
Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
PART - I
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/HR/Approach/41272/2019   (ii). Name of Project for which Forest Land is required : Bharat Petroleum Corporation Ltd. on Khanna Majra-Baknaur Road Village Baknaur Distt Ambala.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of forest Land For Access To Proposed Petrol Pump of Bharat Petroleum Corporation Ltd. On Khanna Majra- Baknaur Road , Village Baknaur Tehsil & Distt Ambala, (Hry) Bearing Khasra No. 55/20, 21/1 , Khatauni No. 153/220.   (iv). State : Haryana   (v). Category of the Proposal : Approach Access   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 25   (viii). Area of forest land proposed for diversion(in ha.): 0.007596   (ix). Non-forest land required for this project(in ha.): 0.122494   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : BHARAT PETROLEUM CORPORATION LIMITED   (ii). Address1 : BPCL POL DEPOT,VILLAGE ALAMGIR POST OFFICE TIWANA, TEHSIL DERABASSI LALRU PUNJAB.   (iii). Address2 : NIL   (iv). State : Haryana   (v). District : Ambala   (vi). Pin : 140501   (vii). Landmark : NIL   (viii). Email address : yogeshslole@bharatpetroleum.in   (ix). Landline Telephone No. : 172-26970925   (x). Fax No. : 172-   (xi). Mobile No. : 9981509608   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Central PSU
A-3. Details of Person Making Application
  (i). First Name: Vipin   (ii). Middle Name: Das   (iii). Last Name: VANSHWAL   (iv). Gender: Male   (v). Designation: Territory manager ambala   (vi). Address 1: BPCL POL DEPOT , VILLAGE ALAMGIR Post office TIWANA, TEH. DERABASSI, LALRU PUNJAB.   (vii). Address 2: NIL   (viii). State: Haryana   (ix). District: Ambala   (x). Tehsil: Ambala   (xi). Pin: 140501   (xii). Landmark: NIL   (xiii). Email Address: yogeshslole@bharatpetroleum.in   (xiv). Landline Telephone No.: 172-2697925   (xv). Fax No.: NIL   (xvi). Mobile No.: 9981509608   (xvii). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency:
B. Details of land required for the Project
B-1. Details of proposal seeking prior approval of Central Government under the Act for diversion of forest land for the Project already submitted in the past
List of proposal submitted in Past
S.no Proposal Status. Proposal No. Moef File No. Area Proposed for Diversion(Ha.) Area Diverted(Ha.) Date of In-Principle Approval Date of Final Approval
NIL
B-2. Details of forest land proposed to be diverted
B-2.1 Details of Divisions involved
Details of Divisions involved
S.no Division Name Forest Land(ha.) Non-Forest Land(ha.)
1.Ambala0.0075960.122494
Total0.0075960.122494
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Ambala0.0075960.122494
Total0.0075960.122494
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Baknaur0.0075960.122494
Total 0.007596 0.122494
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Access to petrol pump0.0075953760.122493
Total 0.007595376 0.122493
C. Maps of forest land proposed to be diverted
Division 1. : Ambala
  (i). Area of forest land proposed to be diverted(in ha.) : 0.007596   (ii). Nature of the Project: Linear   (b). No. of Segments : Two
Segment wise details
Segments Segment Area(in ha.) Kml File of Segments
(To view KML file on google the same may be downloaded and then open if in google earth install in your computer).
1.0.003798    View File
2.0.003798    View File
  (iii). Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted:   (iv). Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS or Total Station:
D. Justification for locating the Project in forest land and details of alternatives examined:
  (i). Copy of note containing justification for locating the Project in forest land:   (ii). Whether a copy of map indicating location of alternative examine is required to be provided: No   (a). Reason for not providing such map: N/A
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 3   (iii). Temporary Employment(Number of person-days): 4
F. Displacement of People due to the Project, if any
  (i). Whether Project involves displacement?: No
G. Details of Cost-Benefit analysis for the Project
  (i). Whether the Project requires Cost-Benefit analysis?: No
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : No
I. Status of Wildelife Clearance
  (i). Whether the Project or a part thereof is located in any Protected Area or their Eco sensitive zone? : No
J. Applicability of special provisions governing Scheduled Areas
  (i).Whether the Project or a part thereof is located in a Scheduled Area? : No
K. Status of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted
  (i). Whether the process for settlement of Rights under the Forest Rights Acts 2006 on the forest land proposed to be diverted has been completed? : No
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: Not Applicable   (ii). Whether the area of non-forest land or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation is less than area of forest land proposed to be diverted ?: Not Applicable   (iii) . Reason for not providing Non-Forest Land: Not Applicable
Additional information Details
Documents
S.No Documents
Remarks
1DM NOC
2DTP NOC
3LOI
4PWD
5POWER OF ATTORNEY
6GOOGLE MAP
7form a
8layout drg
9DFO LETTER
10AFFIDAVIT
11CHECK LIST NO 12
12CHECK LIST NO 13
13undertaking for the payment
14undertaking high tension wire
15undertaking lpg godown
16check list no 10 justification
17ID
18SURVEY MAP
19DGPS MAP
20LEASEDEED
21PWD DRG