Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/UP/DISP/49674/2020   (ii). Name of Project for which Forest Land is required : Forest Land Proposed to diverted for Community Health Center Jokahi-Murdhawa Belt   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Proposed for construction of hospital, school, community building, drinking water supply and toilets in Jokahi-Murdhwa Beat in Pipri Range under Renukoot Forest Division of District Sonbhadra   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Dispensary/Hospital   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 326   (viii). Area of forest land proposed for diversion(in ha.): 0.9594   (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): 30
A-2. Details of User Agency
  (i). Name : NAGAR PANCHAYAT RENUKOOT   (ii). Address1 : NAGAR PANCHAYAT RENUKOOT, SONBHADRA   (iii). Address2 : NIL   (iv). State : Uttar Pradesh   (v). District : Sonbhadra   (vi). Pin : 231217   (vii). Landmark : NIL   (viii). Email address :   (ix). Landline Telephone No. : 5446-000000   (x). Fax No. : 5446-   (xi). Mobile No. : 9450162009   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Dr Anita   (ii). Middle Name: NIL   (iii). Last Name: Shukla   (iv). Gender: Male   (v). Designation: EO   (vi). Address 1: NAGAR PANCHAYAT RENUKOOT, SONBHADRA   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Sonbhadra   (x). Tehsil: Dudhi   (xi). Pin: 231217   (xii). Landmark: NIL   (xiii). Email Address:   (xiv). Landline Telephone No.: 5446-000000   (xv). Fax No.: NIL   (xvi). Mobile No.: 9415923614   (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 Proposal Status. Proposal No. Moef File No. Area Proposed for Diversion(Ha.) Area Diverted(Ha.) Date of In-Principle Approval Date of Final Approval
B-2. Details of forest land proposed to be diverted
B-2.1 Details of Divisions involved
Details of Divisions involved Division Name Forest Land(ha.) Non-Forest Land(ha.)
1.Forest Division Renukoot0.95940
B-2.2 Details of Districts involved
District wise breakup District Name Forest Land(ha.) Non-Forest Land(ha.)
B-2.3 Village wise breakup
Villages wise breakup Village Forest Land(ha.) Non-Forest Land(ha.)
Total 0.9594 0
B-2.4 Component wise breakup
Component wise breakup Component Forest Land(ha.) Non-Forest Land(ha.)
1Costruction of Communities Center0.95940
Total 0.9594 0
C. Maps of forest land proposed to be diverted
Division 1. : Forest Division Renukoot
  (i). Area of forest land proposed to be diverted(in ha.) : 0.9594   (ii). Nature of the Project: Non Linear   (a). No. of patches : Two
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.
1.0.036    View File
2.0.9234    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): 10   (iii). Temporary Employment(Number of person-days): 20000
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
S.No Documents
1Alternative land Certificate
2CA Fund related Certificate
3Forest Cover related Certificate
4GOI and UP Rule Certificate
5Lease and Premium Certificate
6Lease duration Certificate
7Meeting Note
8Muck Disposal detail and Certificate
9NPV Deposit Related Certificate
10NPV Pay Certificate
11Project Establishment
12Proposed Forest Land Detail
13UP Govt Terms and Conditions
14Wildlife related Certificate
15Work not start Certificate
16Area Calculation Details
17Forest Gazzat
18GOI Letter
19Nagar Panchayat Renukoot Letter