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/Approach/149746/2021   (ii). Name of Project for which Forest Land is required : Diversion of 0.0412280 hectare of P.F. land under social forestry div. Hardoi for access road to RO of M/S Reliance BP Mobility Ltd at Vill- Shahbad Andar, Khasra No.- 6887 & 6888, in Chainage- 126.654 on RHS of Shahbad-Hardoi Road, NH-731, Tehsil -Shahbad & District- Hardoi,   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 0.0412280 hectare of P.F. land under social forestry div. Hardoi for access road to RO of M/S Reliance BP Mobility Ltd at Vill- Shahbad Andar, Khasra No.- 6887 & 6888, in Chainage- 126.654 on RHS of Shahbad-Hardoi Road, NH-731, Tehsil -Shahbad & District- Hardoi,   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Approach Access   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 80   (viii). Area of forest land proposed for diversion(in ha.): 0.041228   (ix). Non-forest land required for this project(in ha.): 0.1935   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : M/S RELIANCE BP MOBILITY LIMITED   (ii). Address1 : Eldeco Corporate Chamber-2, 9th Floor, Bibhuti Khand, Gomti Nagar, Lucknow   (iii). Address2 : NIL   (iv). State : Uttar Pradesh   (v). District : Lucknow   (vi). Pin : 226010   (vii). Landmark : NIL   (viii). Email address : karam.jagwani@jiobp.com   (ix). Landline Telephone No. : 0-   (x). Fax No. : 0-   (xi). Mobile No. : 7024264392   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Private
A-3. Details of Person Making Application
  (i). First Name: Pankaj   (ii). Middle Name: NIL   (iii). Last Name: singh   (iv). Gender: Male   (v). Designation: Manager (Sales and Operation)   (vi). Address 1: Eldeco Corporate Chamber-2, 9th Floor, Bibhuti Khand, Gomti Nagar, Lucknow   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Lucknow   (x). Tehsil: Lucknow   (xi). Pin: 226010   (xii). Landmark: NIL   (xiii). Email Address: pankaj.a.singh@jiobp.com   (xiv). Landline Telephone No.: 0-8853381381   (xv). Fax No.: NIL   (xvi). Mobile No.: 8853381381   (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 Hardoi0.0412280.1935
Total0.0412280.1935
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Hardoi0.0412280.1935
Total0.0412280.1935
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Shahbad Andar0.0412280.1935
Total 0.041228 0.1935
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Entry to Retail outlet0.01373750
2Exit to Retail outlet0.01373750
3Area between Entry and Exit0.0137530
4Area of Retail Outlet00.1935
Total 0.041228 0.1935
C. Maps of forest land proposed to be diverted
Division 1. : Social Forestry Division Hardoi
  (i). Area of forest land proposed to be diverted(in ha.) : 0.041228   (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.
1.0.041228    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): 15   (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
1Detail Area Calculation
2Calculation of NPV Levies
3Certificate for Forest Approved Layout Plan
4Certificate of Ambiding rules and Standard Condition
5Fire NOC
6Job not Working Certificate
7Land Documents
8LOI
9MUCK disposal plan
10Pollution NOC
11standard condition
12Undertaking for ETT
13Undertaking for NPV
14Undertaking for CA
15Gazette Notification
16Undertaking for FRA
17NHAI Approved Letter
18NHAI Approved Layout