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/UK/ROAD/13608/2015   (ii). Name of Project for which Forest Land is required : Construction of Mulakot Kande Bhueya Motor Road in district Champawat   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction of Mulakot Kande Bhueya Motor Road in district Champawat   (iv). State : Uttarakhand   (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) : 58.5   (viii). Area of forest land proposed for diversion(in ha.): 3.15   (ix). Non-forest land required for this project(in ha.): 4.95   (x). Total period for which the forest land is proposed to be diverted(in years): NIL
A-2. Details of User Agency
  (i). Name : PUBLIC WORKS DEPARTMENT   (ii). Address1 : PWD office Lohaghat   (iii). Address2 : distt champawat   (iv). State : Uttarakhand   (v). District : Champawat   (vi). Pin : 262524   (vii). Landmark : PWD   (viii). Email address : eepwdlohaghat@rediffmail.com   (ix). Landline Telephone No. : 5965-234525   (x). Fax No. : 5965-234525   (xi). Mobile No. : 9997612578   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Bhuwan   (ii). Middle Name: Bhaskar   (iii). Last Name: Pande   (iv). Gender: Male   (v). Designation: Assitant Engineer   (vi). Address 1: C.D. PWD Lohaghat   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Champawat   (x). Tehsil: Lohaghat   (xi). Pin: 262524   (xii). Landmark: uttrakhand   (xiii). Email Address: eepwdlohaghat@rediffmail.com   (xiv). Landline Telephone No.: 5965-234525   (xv). Fax No.: 05965234525   (xvi). Mobile No.: 8979315093   (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.Champawat3.154.95
Total3.154.95
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Champawat3.154.95
Total3.154.95
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Mulakot, Kande3.154.95
Total 3.15 4.95
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Road3.154.95
Total 3.15 4.95
C. Maps of forest land proposed to be diverted
Division 1. : Champawat
  (i). Area of forest land proposed to be diverted(in ha.) : 3.15   (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).
1.3.15    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: Yes   (a). Copy of map indicating location of alternative examined:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 70   (iii). Temporary Employment(Number of person-days): 6000
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? : 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?: Yes   (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 ?: No   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Champawat
  (a). Village: Nidle   (b). Area(in ha.): 1   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 7177   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
District 2. : Champawat
  (a). Village: Bibil   (b). Area(in ha.): 5.3   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 6179,6183,6160   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
  (v). Scanned copy of the map of the land identified for creation of Compensatory Afforestation prepared by using GPS ot Total Station:   (vi). Copy of Survey of India Toposheet in 1:50,000 scale indicating location of the land identified for creation of Compensatory Afforestation:
Additional information Details
Documents
S.No Documents
Remarks
1Competence/authority of person making this application
2Survey of India Toposheet
3GEO referenced Map by using GPS
4Google map of proposed site
5Containing Justification for locating the project in forest land
6Forest right Act-2006
7copy of ownership proof & No objection certificate
8agreement between the owner & user agency
9Cost benefit anylisises
10Short narrative & importance of the project
11Administrative & financial Section
12Joint inspection report
13Comparative Chart showing statement of both alignment
14Certificate form the DM that no alternative suitable non-forest land
15Land Schedule
16Land Schedule
17Land Schedule
18Category wise land length, width & area
19Bar chart
20Compensatory afforestation by DFO
21Compensatory afforestation by DFO
22Undertaking by the user agency to bear the cost of road side plantation
23Road side filling plantation estimate
24Undertaking by the user agency to bear cost...
25Certificate to 100 trees
26Details of the trees
27Details of the trees
28Details of the trees
29Detail of oak trees
30felling of trees is not involved certificate by DFO
31certificate of felling minimum trees
32Muck disposal scheme
33Certificate of National park or sanctuary distance
34Certificate of 10 km radius N/P or centuary
35Certificate of 10 km radius N/P or centuary
36Forest Act 1980
37NOC from Local Gram Sabhas
38Component wise details of construction work
39Certificate of work has not been started
40Geologist Report
41Task force report
42complying the condition imposed in standard condition
43complying the condition imposed geologist report
44Certificate of no historical place
45Certificate of no animal will be effected
46Certificate of provided alternative fuelwood kerosece of lpg
47Benefited village, families, population
48NPV calculation certificate
49Undertaking of payment of NPV
50cost of forest land & lease rand certificate
51certificate of lease period
52Demarcation of land
53Undertaking of user agency to bear the cost of demarcation
54Non availability non-forest land of CA
55Praroop-1
56Praroop-2
57Land schedule of Reserved forest
58NOC from Vanpanchayat & Grame Sabha
59Revised CA of 6.300 ha. Scheme, Toposheet, Digital map & Suitability certificate & Other papers etc.
60Please Review the Correction
61Please Review the Correction
62compensatory afforestation scheme in civil land
63Colored copy of the google map
64Compensatory afforestation scheme
65suitability of identified Land
66Objection sought R.O. has been removed