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/Others/30840/2017   (ii). Name of Project for which Forest Land is required : Proposed Forest Land for Approach Road (Exit/Entry) for Hindustan Petroleum corporation Limited Retail Outlet On NH-91, Ghaziabad - Aligarh Road CH. 59.180 (RHS) Khasra No. 165, Village:Lalpur, Tehsil: sikandrabad , District : Bulandshahar   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Proposal for diversion of protected forest land for non -forestry purpose to construct the approach road for entry, exit & buffer strip to proposed retail outlet by 'HPCL'at km chainage 59.180(RHS) of NH-91,at Khasara no. 165, vill. Lalpur, Teh.- Sikandrabad, Distt.- Bulandshahar   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Others   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 60   (viii). Area of forest land proposed for diversion(in ha.): 0.1689245   (ix). Non-forest land required for this project(in ha.): 0.18   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : Hindustan Petroleum Corporation Limited   (ii). Address1 : 85/4, ISPAT BHAWAN, THIRD FLOOR, SANJAY PLACE, AGRA   (iii). Address2 : NIL   (iv). State : Uttar Pradesh   (v). District : Agra   (vi). Pin : 282002   (vii). Landmark : NIL   (viii). Email address : hpclagraro@gmail.com   (ix). Landline Telephone No. : 562-2523076   (x). Fax No. : 562-2523024   (xi). Mobile No. : 9837091954   (xii). Website (if any) : www.hindustanpetroleum.com   (xiii). Legal status of User Agency : Central PSU
A-3. Details of Person Making Application
  (i). First Name: Aditya   (ii). Middle Name: Vikram   (iii). Last Name: Singh   (iv). Gender: Male   (v). Designation: CHIEF REGIONAL MANAGER   (vi). Address 1: 85/4,ISPAT BHAWAN, THIRD FLOOR, SANJAY PLACE, AGRA   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Agra   (x). Tehsil: Agra   (xi). Pin: 282002   (xii). Landmark: NIL   (xiii). Email Address: hpclagraro85@gmail.com   (xiv). Landline Telephone No.: 562-2523076   (xv). Fax No.: 05622523024   (xvi). Mobile No.: 9847233383   (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.Social Forestry Division Bulandshahar0.16892450.18
Total0.16892450.18
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Bulandshahr0.16892450.18
Total0.16892450.18
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1LALPUR0.16892450.18
Total 0.1689245 0.18
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1MIDDLE PART BETWEEN ENTRY & EXIT0.06749420
2ENTRY TO RETAIL OUTLET0.03781930
3EXIT TO RETAIL OUTLET0.0636110
4AREA OF RETAIL OUTLET00.18
Total 0.1689245 0.18
C. Maps of forest land proposed to be diverted
Division 1. : Social Forestry Division Bulandshahar
  (i). Area of forest land proposed to be diverted(in ha.) : 0.1689245   (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.
1.0.1689245    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): 500
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
1NHAI APPROVED DRAWING
2NOC LETTER FROM NHAI
3NOC FROM DM Bulandshahar
4CA CERTIFICATE
5NPV CERTIFICATE
6FOREST AREA LAND CERTIFICATE
7DETAIL AREA CALCULATION OF FOREST & NON FOREST LAND
8undertaking rules and regulation
9LOI TO DEALER
10POLLUTION NOC
11FIRE NOC
12NHAI LETTER 22-03-2013
13forest gazettee notification of land
14DFO REport about Access Road for Entry and Exit
15Mak disposal certificate
16Standard condition certificate
17Standard Condition Certificate
18Acknowledgement slip by DFO Bulandshahar