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/38545/2019   (ii). Name of Project for which Forest Land is required : Construction of CC Road Gajari Pandey Golju Mandir in Kotabagh Block District Nainital   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction of CC Road Gajari Pandey Golju Mandir in Kotabagh Block District Nainital (Van Panchayat Forest Land 0.360 hect) At present no other way for Golju Mandir. After Construction this Road related villagers will be benefited.   (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) : 0.5   (viii). Area of forest land proposed for diversion(in ha.): 0.36   (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 : PWD RAMNAGAR   (ii). Address1 : Construction Division, Ramnagar (Nainital)   (iii). Address2 : NIL   (iv). State : Uttarakhand   (v). District : Nainital   (vi). Pin : 244715   (vii). Landmark : NIL   (viii). Email address : eecdrmr@rediffmail.com   (ix). Landline Telephone No. : 5947-254591   (x). Fax No. : 5947-254591   (xi). Mobile No. : 9411161148   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Others
A-3. Details of Person Making Application
  (i). First Name: Mahendra   (ii). Middle Name: NIL   (iii). Last Name: Kumar   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: Construction Division, Ramnagar (Nainital)   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Nainital   (x). Tehsil: Ramnagar   (xi). Pin: 244715   (xii). Landmark: NIL   (xiii). Email Address: eecdrmr@rediffmail.com   (xiv). Landline Telephone No.: 5947-254591   (xv). Fax No.: 05947254591   (xvi). Mobile No.: 9412023055   (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.Ramnagar0.360
Total0.360
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Nainital0.360
Total0.360
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Pandey Gaon (Gajari)0.360
Total 0.36 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1GPandy Gaon (Van Panchayat)0.360
Total 0.36 0
C. Maps of forest land proposed to be diverted
Division 1. : Ramnagar
  (i). Area of forest land proposed to be diverted(in ha.) : 0.36   (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).
1.0.36    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: Other
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 0   (iii). Temporary Employment(Number of person-days): 100
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?: 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
1Check List
2Fact Sheet
3Prativadan
4Justification
5Govt of India G.O.
6Scientific Name
7Joint Inspection Report
8Site Inspection Report
9Land Schedule
10Tree Cutting Certificate
11Bajh Tree Cutting Certificate
12National Park and Wild Life Century Certificate
13Topo Sheet
14Geo Refrance Sheet
15Compansatry Plantation Amount Aklan
16Compansatry Plantation Importance Certificate
17Bar Chart
18Rikt Place Plantation Certificate
19Dus Guna Plantation Certificate
20NOC Aam Sabha
21FRA
22DM Certificate
23Length and Width Certificate
24Geological Report
25Geological and District Task Force Report
26Task Force Certificate
27No effect Wild Animal Certificate
28Minimum Forest Land Demand Certificate
29Religious and Historical Place Certificate
30Village Family Population Benefit Certificate
31Duguna Avatan Compensatory Plantation Amount Submitted Certificate
32Estimate
33Environment Certificate
34Forest Land Cost Certificate
35NPV Certificate
36No Special Place Certificate
37Muck Dumping
38Standard Condition
39RCC Pillar Praklan
40Lay Out Plan
41Minimum Tree Cutting Certificate
42No Violance Forest Land Act 1980
43Gairvaniky Compensatory Plantation Certificate
44Minimum Land Certificate
45Coocking Gas Certificate
46Blasting Certificate
47Cancel Alingment Effected Tree List
48Check List Certificate
49Khatoni
50Require Document Submitted
51Require Document Submitted
52Require Document submitted
53Require Document Submitted
54EDS Dt. 19.11.2019 Topo Sheet, Geo Refrence map And Google Map Counter Sign by D.M.
55EDS Dt. 19.11.2019 Topo Sheet Counter Sign by D.M.
56EDS Dt. 19.11.2019 Geo Refrence map Counter Sign by D.M.
57EDS Dt. 19.11.2019 Google Map Counter Sign by D.M.
58EDS 15.09.2020 Arrial Distance
59EDS Dt. 15.09.2020 Forwarding Letter for Arrear Distance
60EDS 26.10.2020
61EDS 26.10.2020 Arial Distance Certificate
62EDS Dt. 26.10.2020 Distance Certificate
63EDS Dt. 26.10.2020 Forwarding Letter