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/KA/QRY/39019/2019   (ii). Name of Project for which Forest Land is required : BUILDING STONE QUARRY IN SY NO 103 OF KHURSE VILLAGE ,SIRSI TALUK , UTTARAKANNADA DISTRICT FOR THE EXCLUSIVE USE OF NHAI ROAD PROJECT   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Ordinary building stone quarry required for the purpose of producing the aggregates for the construction of National Highway road project.   (iv). State : Karnataka   (v). Category of the Proposal : Quarrying   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 450   (viii). Area of forest land proposed for diversion(in ha.): 2.632   (ix). Non-forest land required for this project(in ha.): 0   (x). Total period for which the forest land is proposed to be diverted(in years): 5
A-2. Details of User Agency
  (i). Name : RNS INFRASTRUCTURE LIMITED, BANGALURU 560 001   (ii). Address1 : RNS Infrastructure Limited, Naveen Complex, 7th Floor, 14, M.G. Road, Bengaluru- 560 001   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Bangalore Urban   (vi). Pin : 560001   (vii). Landmark : Trinity Circle   (viii). Email address : rnsilgplkumtasirsi@gmail.com   (ix). Landline Telephone No. : 80-42897000   (x). Fax No. : 80-25584017   (xi). Mobile No. : 9448065926   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Private
A-3. Details of Person Making Application
  (i). First Name: Sanjeev   (ii). Middle Name: K   (iii). Last Name: Shetty   (iv). Gender: Male   (v). Designation: Projectdirector   (vi). Address 1: RNS Infrastructure Limited. Naveen Complex, 7th Floor, 14, M.G. Road, Bengaluru- 560 001   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Bangalore Urban   (x). Tehsil: Bangalore East   (xi). Pin: 560001   (xii). Landmark: Trinity Circle   (xiii). Email Address: rnsilgplkumtasirsi@gmail.com   (xiv). Landline Telephone No.: 80-42897000   (xv). Fax No.: 08025584017   (xvi). Mobile No.: 9448065926   (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.Sirsi2.6320
Total2.6320
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Uttara Kannada2.6320
Total2.6320
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1KHURSE, Forest Sy No. 1032.6320
Total 2.632 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Area for Mining1.9030
2Approach Road Internal Roads0.2330
3Overburden dump Area0.0810
4Mineral storage0.1010
5Topsoil Yard0.0510
6Infrastructure0.020
7Green belt/Afforestation0.2430
Total 2.632 0
C. Maps of forest land proposed to be diverted
Division 1. : Sirsi
  (i). Area of forest land proposed to be diverted(in ha.) : 2.632   (ii). Nature of the Project: Non Linear   (a). No. of patches : One
Patch wise details
Patch No. Area of Patch(in ha.) Kml File of PatchesTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.2.632    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:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 53   (iii). Temporary Employment(Number of person-days): 79500
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 ? : Yes   (a). Status of the Environmental Clearance to the Project: EC application yet to be submitted
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? : Yes   (a). Copy of documentry evidence in support of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted:
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: Yes   (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 ?: No   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Uttara Kannada
  (a). Village: Teppara   (b). Area(in ha.): 2.632   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Sy No. 18/2, 18/3, 18/4,18/5, 18/6, 19/2 & 19/3   (e). Present owner: User Agency   (f). Copy of Ownership proof:
  (v). Scanned copy of the map of the land identified for creation of Compensatory Afforestation prepared by using GPS ot Total Station:   (vi). Copy of Survey of India Toposheet in 1:50,000 scale indicating location of the land identified for creation of Compensatory Afforestation:
Additional information Details
Documents
S.No Documents
Remarks
1Project Report
2Compensatory afforestation undertaking
3Compensatory afforestation land maintenance
4Forest land NPV Undertaking
5Forest land additional NPV Undertaking
6CA Land Issa wise Statement
7Revenue Map of issas Different
8Proposed Quarry & Approach Road Coordinates-20m
9Compliance Report-21-03-2019
10The Alternative item D(ii) is selected YES & the Maps are already uploaded in item number D(ii)(a), but the same Item is not displaying in the preview sheet. Hence additional same copy attached here.
11Extraction transportation Undertaking