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/RJ/ROAD/116513/2020
(ii). Name of Project for which Forest Land is required :
“Construction of Approach Road for Proposed Hindustan Petroleum Corporation Retail Outlet on Fatehpur to Sikar Road NH-52(RHS) on Khasra No-1165/1160 (Old Khasra 813/580) Chainage 359/941 to 359/97
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
“Construction of Approach Road for Proposed Hindustan Petroleum Corporation Retail Outlet on Fatehpur to Sikar Road NH-52(RHS) on Khasra No-1165/1160 (Old Khasra 813/580) Chainage 359/941 to 359/976, At Village – Rashidpura, Tehsil - Dhodh, District – Sikar(Rajasthan)”
(iv). State :
Rajasthan
(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) :
45
(viii). Area of forest land proposed for diversion(in ha.):
0.1335
(ix). Non-forest land required for this project(in ha.):
0.1805
(x). Total period for which the forest land is proposed to be diverted(in years):
19.99
A-2.
Details of User Agency
(i). Name :
HINDUSTAN PETROLIUM CORPORATION LIMITED
(ii). Address1 :
TEL BHAWAN,SAHAKAR MARG,JYOTI NAGAR ,JAIPUR
(iii). Address2 :
NIL
(iv). State :
Rajasthan
(v). District :
Jaipur
(vi). Pin :
302005
(vii). Landmark :
NEAR SAHAKAR BHAWAN
(viii). Email address :
shabbirkhan1051@gmail.com
(ix). Landline Telephone No. :
141-2740358
(x). Fax No. :
141-
(xi). Mobile No. :
7014560943
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
Central PSU
A-3.
Details of Person Making Application
(i). First Name:
SANJAY
(ii). Middle Name:
KUMAR
(iii). Last Name:
SHARMA
(iv). Gender:
Male
(v). Designation:
GeneralManager
(vi). Address 1:
TEL BHAWAN, SAHAKAR MARG, JYOTI NAGAR , JAIPUR
(vii). Address 2:
NIL
(viii). State:
Rajasthan
(ix). District:
Jaipur
(x). Tehsil:
Jaipur
(xi). Pin:
302005
(xii). Landmark:
NIL
(xiii). Email Address:
shabbirkhan1051@gmail.com
(xiv). Landline Telephone No.:
141-2740358
(xv). Fax No.:
NIL
(xvi). Mobile No.:
7014560943
(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.
Sikar Territorial
0.1335
0.1805
Total
0.1335
0.1805
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Sikar
0.1335
0.1805
Total
0.1335
0.1805
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Rashidpura
0.1335
0.1805
Total
0.1335
0.1805
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Deceleration Lane (LHS)
0.0525
0.0115
2
Acceleration Lane(RHS)
0.066
0.0115
3
Front Side Service Road
0.015
0
4
Proposed Retail Outlet
0
0.1575
Total
0.1335
0.1805
C.
Maps of forest land proposed to be diverted
Division 1. : Sikar Territorial
(i). Area of forest land proposed to be diverted(in ha.) :
0.1335
(ii). Nature of the Project:
Linear
(b). No. of Segments :
Three
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.
0.0525
View File
2.
0.066
View File
3.
0.015
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:
NH-52 (OLD NH-11) ROW DECLARED PROTECTED FOREST ST
E.
Employment likely to be generated
(i). Whether the Project is likely to generate employment ?:
Yes
(ii). Permanent/Regular Employment(Number of persons):
9
(iii). Temporary Employment(Number of person-days):
250
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
1
POWER OF ATTORNEY
2
CERTIFICATE FOR MINIMUM USE OF FOREST LAND
3
JUSTIFICATION FOR LOCATING THE PROJECT IN FOREST AREA
4
UNDERTAKING FOR CONSERVATION OF FLORA-FAUNA AND WILDLIFE ANIMALS DURING ROAD CONSTRUCTION
5
UNDERTAKING FOR FRA CERTIFICATE
6
UNDERTAKING FOR HIGH TENSION LINE
7
UNDERTAKING FOR LP GAS GODOWN
8
UNDERTAKING FOR MUCK DISPOSAL DURING CONSTRUCTION OF ROAD
9
UNDERTAKING FOR NO CHANGES IN STATUTORY POSITION OF DIVERTED FOREST LAND
10
UNDERTAKING FOR PAYMENT OF ANY OTHER COST AND CONDITION
11
UNDERTAKING FOR PAYMENT OF COST OF COMPENSATORY AFFORESTATION
12
UNDERTAKING FOR PAYMENT OF NET PRESENT VALUE OF FOREST AREA
13
UNDERTAKING FOR SITE SELECTION AND DISTANCE BETWEEN RETAIL OUTLET ON EITHER SIDE
14
UNDERTAKING FOR USE OF ANY MATERIAL FROM SURROUNDED FOREST LAND DURING CONSTRUCT ROAD
15
UNDERTAKING FOR WASTE MANAGEMENT DURING CONSTRUCTION ACTIVITY
16
AREA CALUCALTION SHEET
17
STATEMENT SHOWING DETAILS OF FOREST AREA PROPOSED FOR DIVERSION
18
STATEMENT SHOWING DETAILS OF NON-FOREST AREA PROPOSED FOR DIVERSION
19
PROJECT RE REPORT
20
LOI LETTER
21
MORTH PERMISSION
22
DISTRICT MAGISTRAT LETTER REGARGDING NO OBJECTION CERTIFICATE LETTER
23
JAMABANDI AND KHASRA MAP
24
KHASRA SUPER IMPOSED PROJECT
25
LAND DOCUMENTS
26
BAR CHART STATUS
27
APPROVED LAY OUT PLAN
28
Details of Permanent Employment to be Generated
29
Geo-Referenced Survey of India Toposheet with HPCL Retail Outlet Full Toposheet No OMS -G43-D/2(45M/2) SCALE 1 : 50000
30
Geo-Referenced DGPS MAP With Required Land Coordinate
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