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/HR/Approach/45649/2020   (ii). Name of Project for which Forest Land is required : Existing Retail Outlet of RIL, at village Adampur Mandi, Distt. Hisar.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 0.0125 Hac. forest land along on adampur-Agroha/Delhi Road, at village Adampur Mandi, Tehsil, Adampur, Distt.Hisar.   (iv). State : Haryana   (v). Category of the Proposal : Approach Access   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 30   (viii). Area of forest land proposed for diversion(in ha.): 0.0181   (ix). Non-forest land required for this project(in ha.): 0.2295   (x). Total period for which the forest land is proposed to be diverted(in years): 15
A-2. Details of User Agency
  (i). Name : RELIANCE INDUSTRIES LTD   (ii). Address1 : Reliance House, R.K. Squre, Building no. 4, DLF Cyber City phase-II, Gurgaon,   (iii). Address2 : NIL   (iv). State : Haryana   (v). District : Gurgaon   (vi). Pin : 122002   (vii). Landmark : NIL   (viii). Email address : ril.gurgaon.hisar@gmail.com   (ix). Landline Telephone No. : 1662-00000000   (x). Fax No. : 1662-   (xi). Mobile No. : 9416266173   (xii). Website (if any) : www.ril.com   (xiii). Legal status of User Agency : Private
A-3. Details of Person Making Application
  (i). First Name: Arjun   (ii). Middle Name: NIL   (iii). Last Name: Mukherjee   (iv). Gender: Male   (v). Designation: GM Business Development   (vi). Address 1: Reliance House, R.K. Squre Building no.4, DLF phase -II, Gurgaon.   (vii). Address 2: NIL   (viii). State: Haryana   (ix). District: Gurgaon   (x). Tehsil: Gurgaon   (xi). Pin: 122002   (xii). Landmark: NIL   (xiii). Email Address: ril.gurgaon.hisar@gmail.com   (xiv). Landline Telephone No.: 0-00000000   (xv). Fax No.: NIL   (xvi). Mobile No.: 9416266173   (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.Hisar0.01810.2295
Total0.01810.2295
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Hisar0.01810.2295
Total0.01810.2295
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Adampur0.01810.2295
Total 0.0181 0.2295
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Approach for Retail Outlet0.01810.2295
Total 0.0181 0.2295
C. Maps of forest land proposed to be diverted
Division 1. : Hisar
  (i). Area of forest land proposed to be diverted(in ha.) : 0.0181   (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).
1.0.0181    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): 1   (iii). Temporary Employment(Number of person-days): 5
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
1Letter to DFO
2Authority letter
3LEASE DEED
4JAMABANDI
5aks sajra plan by halka patwari
6All check list
7forest area calculation drawing
8DTP NOC
9UNDERTAKING REGARDING FRA Letter
10Pwd Letter
11HUDA NOC
12LOI