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/Pipeline/143750/2021
(ii). Name of Project for which Forest Land is required :
Diversion of 0.642 Ha. of Forest Land for laying of AGL Natural Gas 200 MM Dia Carbon Steel Pipeline along Jhansi – Kanpur NH-27 from Medical Tiraha to Pahari Bujurg near Chirgaon Bypass for Approx. 21.400KM left side from (Ch. 1396 +100 to 1417+500 KM) in District – Jhansi (U.P.)
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Diversion of 0.642 Ha. of Forest Land for laying of AGL Natural Gas 200 MM Dia Carbon Steel Pipeline along Jhansi – Kanpur NH-27 from Medical Tiraha to Pahari Bujurg near Chirgaon Bypass for Approx. 21.400KM left side from (Ch. 1396 +100 to 1417+500 KM) in District – Jhansi (U.P.)
(iv). State :
Uttar Pradesh
(v). Category of the Proposal :
Pipeline
(vi). Shape of forest land proposed to be diverted :
Linear
(vii). Estimated cost of the Project(Rupees in lacs) :
1250
(viii). Area of forest land proposed for diversion(in ha.):
0.642
(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):
99
A-2.
Details of User Agency
(i). Name :
ADANI TOTAL GAS LIMITED
(ii). Address1 :
2nd Floor, SARC Raj Estate Building, Jhansi Gwalior Road, Jhansi
(iii). Address2 :
NIL
(iv). State :
Uttar Pradesh
(v). District :
Jhansi
(vi). Pin :
284003
(vii). Landmark :
NIL
(viii). Email address :
adaniupnoc@gmail.com
(ix). Landline Telephone No. :
0-
(x). Fax No. :
0-
(xi). Mobile No. :
8155077780
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
Private
A-3.
Details of Person Making Application
(i). First Name:
Rajan
(ii). Middle Name:
Kumar
(iii). Last Name:
Singh
(iv). Gender:
Male
(v). Designation:
Deputy Manager
(vi). Address 1:
2nd Floor, SARC Raj Estate Building, Jhansi Gwalior Road, Jhansi
(vii). Address 2:
NIL
(viii). State:
Uttar Pradesh
(ix). District:
Jhansi
(x). Tehsil:
Jhansi
(xi). Pin:
284003
(xii). Landmark:
NIL
(xiii). Email Address:
adaniupnoc@gmail.com
(xiv). Landline Telephone No.:
0-
(xv). Fax No.:
NIL
(xvi). Mobile No.:
8155077780
(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.
Forest Division Jhansi
0.642
0
Total
0.642
0
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Jhansi
0.642
0
Total
0.642
0
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Jhansi Bypass (Bundelkhand university) to Kochha B
0.036
0
2
Kochha Bhanwar to Digara
0.048
0
3
Digara to Karguwan
0.045
0
4
Karguwan to Goramachiya
0.06
0
5
Goramachiya to Baragaon
0.039
0
6
Baragaon to Bachaoli khurd
0.072
0
7
Bachaoli khurd to Paricha
0.123
0
8
Paricha to Pahadi
0.105
0
9
Pahadi to Richhaura
0.063
0
10
Richhaura to Khadeshwar (Chirgaon Bypass)
0.051
0
Total
0.642
0
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Adani Total Gas Pipeline
0.642
0
Total
0.642
0
C.
Maps of forest land proposed to be diverted
Division 1. : Forest Division Jhansi
(i). Area of forest land proposed to be diverted(in ha.) :
0.642
(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.
0.642
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:
No
(a). Reason for not providing such map:
NA
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):
35
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
1
NHAI Undertaking
2
CGD Authorization Letter
3
Forest Area Calculation & Layout Plan
4
Chirgaon NHAI Application
5
Power of Attorney
6
Routemap
7
FRA Undertaking
8
Forest Area Calculation Sheet
9
Muck Disposal Plan
10
Forest Standard Conditions Undertaking
11
Forest Notification Gazette
12
Certificate for Task Force
13
Undertaking for not start of work
14
Undertaking for GOI FN-2014
15
Certificate for Van Swaroopi area
16
Certificate for NPV
17
Certificate for optional land
18
Undertaking for acceptance of UP Govt conditions.
19
Undertaking for CA Land
Print