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/UP/Approach/154875/2022   (ii). Name of Project for which Forest Land is required : Proposed Indian Oil retail outlet at Survey No. 664, 665 & 666 on Left Hand Side of NH-92 (new NH-719) at Chainage 75.609 Village Udi, Tehsil Etawah & District Etawah.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Proposal for diversion of Protected Forest land for construction of approach access road with entry & exit points for proposed Indian Oil retail outlet at Survey No. 664, 665 & 666 on Left Hand Side of NH-92 (new NH-719) at Chainage 75.609 Village Udi, Tehsil Etawah & District Etawah.   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Approach Access   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 55   (viii). Area of forest land proposed for diversion(in ha.): 0.0874   (ix). Non-forest land required for this project(in ha.): 0.3424   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : INDIAN OIL CORPORATION LIMITED   (ii). Address1 : Indian Oil Corporation Limited, 65/2, Sanjay Place , Agra Divisional Office , Agra   (iii). Address2 : NIL   (iv). State : Uttar Pradesh   (v). District : Agra   (vi). Pin : 282002   (vii). Landmark : NIL   (viii). Email address : gauravk@gov.in   (ix). Landline Telephone No. : 0--   (x). Fax No. : 0-   (xi). Mobile No. : 7217333796   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Central Government
A-3. Details of Person Making Application
  (i). First Name: Kumar   (ii). Middle Name: NIL   (iii). Last Name: Gaurav   (iv). Gender: NIL   (v). Designation: Senior Manager (Retail Sales)   (vi). Address 1: Indian Oil Corporation Limited, 65/2, Sanjay Place , Agra Divisional Office , Agra   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Agra   (x). Tehsil: NIL   (xi). Pin: 282002   (xii). Landmark: NIL   (xiii). Email Address: gauravk@indianoil.in   (xiv). Landline Telephone No.: 0-   (xv). Fax No.: NIL   (xvi). Mobile No.: 9654163869   (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.Chambal Wild Life Division Agra0.08740.3424
Total0.08740.3424
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Etawah0.08740.3424
Total0.08740.3424
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Udi0.08740.3424
Total 0.0874 0.3424
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Approach access with entry & exit for retail outle0.08740.3424
Total 0.0874 0.3424
C. Maps of forest land proposed to be diverted
Division 1. : Chambal Wild Life Division Agra
  (i). Area of forest land proposed to be diverted(in ha.) : 0.0874   (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.
1.0.0874    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): 5   (iii). Temporary Employment(Number of person-days): 700
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? : Yes   (a). Whether Project or a part thereof is located within a Protected Area ? : Yes   (b). Status of approval of the Supreme Court : Application yet to b   (ii). Status of approval of the Standing Committee of National Board for the Wildlife(NBWL) to the Project : Application yet to be submitted
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
1Gazette Notification declaring Protected Forest
2Undertaking to provide No Objection Certificate from NHAI
3Certificate for minimum use of forest land, undertakings towards: C.A. payment, N.P.V. payment, differential N.P.V. payment, Owner department N.O.C., No Labour Camps in Forest Area, Non Violation of FCA, F.R.A Certificate & involvement of P.A. & E.S.Z. Muck Disposal Plan etc.
4Undertaking for providing FRA Certificate
5Undertaking to abide by Standard Conditions imposed by State Government.
6No Objection Certificate from UPSPCB for construction of proposed retail outlet (CTE)
7No Objection Certificate from Fire Control department for construction of proposed retail outlet.
8manak sharten
9latter of intent by IOCL
10khatauni
11van swaroop certificate
12undertaking for ETT
13undertaking for minimum tree cutting
14certificate for guideline 11.07.2014
15undertaking for no work start
16cte for guidline 18-03-2010
17area calculation