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/KA/ROAD/41432/2019   (ii). Name of Project for which Forest Land is required : Construction of proposed 4 lane ROB and its approachers in lieu of existing level crossing No. 48/E @ km 66.900 on NH-50 (Railway Chainage 96/6-7) near Noubad in the state of Karnataka   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction of Road over bridge at Km 66.900 on NH-50 (Railway Chainage 96/6-7) Near Naubad in Bidar District   (iv). State : Karnataka   (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) : 9107   (viii). Area of forest land proposed for diversion(in ha.): 0.3221   (ix). Non-forest land required for this project(in ha.): 8.0713   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : EXECUTIVE ENGINEER NATIONAL HIGHWAY DIVISION   (ii). Address1 : H No 11/1844 Back side SB College Vidyanagar,Kalaburagi   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Gulbarga   (vi). Pin : 585103   (vii). Landmark : SB College, Vidyanagar. Kalaburagi   (viii). Email address : eenhdnklb@gmail.com   (ix). Landline Telephone No. : 8472-222783   (x). Fax No. : 8472-   (xi). Mobile No. : 9448038789   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Executive Engneer   (ii). Middle Name: NIL   (iii). Last Name: NH Division Kalaburgi   (iv). Gender: Male   (v). Designation: EE   (vi). Address 1: H No 11/1844 Back side SB College Vidyanagar, kalaburgi   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Gulbarga   (x). Tehsil: Gulbarga   (xi). Pin: 585103   (xii). Landmark: H No 11/1844 Back side SB College vidya nagar kala   (xiii). Email Address: chavanee0@gmail.com   (xiv). Landline Telephone No.: 8472-222783   (xv). Fax No.: 08472222783   (xvi). Mobile No.: 9945455503   (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.Bidar0.32218.0713
Total0.32218.0713
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Bidar0.32218.0713
Total0.32218.0713
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Naubad0.32214.7793
2Kolhar K03.292
Total 0.3221 8.0713
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Carriageway0.1164.1414
2Island0.00130
3Median0.019230.2345
4Earthen Shoulder00.7893
5Drain00.7893
6Service road01.4985
7Toe0.021920.4247
8ROW0.163650.1936
Total 0.3221 8.0713
C. Maps of forest land proposed to be diverted
Division 1. : Bidar
  (i). Area of forest land proposed to be diverted(in ha.) : 0.3221   (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).
1.0.3221    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): 500   (iii). Temporary Employment(Number of person-days): 2250
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 ? : Yes   (a). Status of the Environmental Clearance to the Project: EC application yet to be submitted
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?: 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
1Justification for 45m ROW
2Survey Wise Break up details
3Undertaking
4Alignment Plan
5Letter for uploading new Proposal for Naubad ROB
6Compliance letter for old Proposal ( FP/KA/ROAD/36137/2018)