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/UK/ROAD/10904/2015   (ii). Name of Project for which Forest Land is required : Construction of Ghapani to Dadhuli Motor Road under PMGSY.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction of New Road   (iv). State : Uttarakhand   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 470.75   (viii). Area of forest land proposed for diversion(in ha.): 3.005   (ix). Non-forest land required for this project(in ha.): 3.048   (x). Total period for which the forest land is proposed to be diverted(in years): NIL
A-2. Details of User Agency
  (i). Name : PMGSY   (ii). Address1 : E.E. PMGSY DIV. PWD. Dwarahat   (iii). Address2 : NIL   (iv). State : Uttarakhand   (v). District : Almora   (vi). Pin : 263653   (vii). Landmark : Dwarahat   (viii). Email address : eepmgsypwddwarahat@gmail.com   (ix). Landline Telephone No. : 5966-244171   (x). Fax No. : 5966-0   (xi). Mobile No. : 9411289401   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Rajendra   (ii). Middle Name: Lal   (iii). Last Name: Sah   (iv). Gender: Male   (v). Designation: Assistant Engineer   (vi). Address 1: E.E. PMGSY DIV. PWD. Dwarahat   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Almora   (x). Tehsil: Dwarahat   (xi). Pin: 263653   (xii). Landmark: Dwarahat   (xiii). Email Address: eepmgsypwddwarahat@gmail.com   (xiv). Landline Telephone No.: 5966-244171   (xv). Fax No.: NIL   (xvi). Mobile No.: 9410364031   (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.Almora3.0053.048
Total3.0053.048
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Almora3.0053.048
Total3.0053.048
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Dadhuli3.0053.048
Total 3.005 3.048
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Civil Soyam Land3.0053.048
Total 3.005 3.048
C. Maps of forest land proposed to be diverted
Division 1. : Almora
  (i). Area of forest land proposed to be diverted(in ha.) : 3.005   (ii). Nature of the Project: Linear   (b). No. of Segments : One
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).
1.3.005    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: Yes   (a). Copy of map indicating location of alternative examined:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 130   (iii). Temporary Employment(Number of person-days): 280
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? : 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. : Pithoragarh
  (a). Village: Saaukuri   (b). Area(in ha.): 175.719   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 17 Nos Attached   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
  (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
12.1- A short Narrative
22.2- Administrative and Financial Sanction
32.3- Joint Inspection
42.4- comparative Chart
52.5- DM Certificate
62.6- Land Schedule
72.7- Category wise land length, width and area in Ha.
82.8- Bar Chart
92.9- CA Scheme
102.10- Certificate CA
112.11- Cost of CA
122.12- Road Side/gap Filling plantation estimate.
132.13- Cost of Road side/gap filling plantation
142.15- Details of trees
152.18- Certificate of felling minimum trees during the project work
162.19- Muck Disposal
172.20- whather project area is a part of National park
182.23- No voilation
192.24- NOC
202.27- certificate = work has not been started
212.28- Geologist Report
222.29- Task Force report
232.30- Standard Condition
242.31- Certificate for complying the condition imposed in standard condition
252.32- Certificate for complying the condition imposed in geologist report
262.33- No historical/Monumental effected certificate
272.34- No animal effected certificate
282.35- Alternative fuelwood kerosene or LPG to labours involved in project
292.36- Benefited Villages
302.37- NPV Calculation Certificate
31ghapnai 2.10 Certificate regarding suitability of indentified land for CA.
322.38- Rates of NPV
332.44- Check list/Fact Sheet