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/35700/2018   (ii). Name of Project for which Forest Land is required : IOCl New retail outlet at Village Shubhdand District Nagaur   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 0.1887 ha forest land for construction of approach road for a proposed retail outlet of IOCL along the NH-89 (Nagaur –Merta City ROAD)LHS, Part of khasra no. 209/108, at village Shubhdand, Tehsil Merta City, District. Nagaur, (Raj.). Betw k.m. 83-84 (Ch 83+497.60-83+532.60)LHS   (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) : 50   (viii). Area of forest land proposed for diversion(in ha.): 0.1887   (ix). Non-forest land required for this project(in ha.): 0.2145   (x). Total period for which the forest land is proposed to be diverted(in years): 19.91
A-2. Details of User Agency
  (i). Name : INDIAN OIL CORPRATION LIMITED   (ii). Address1 : 24 Sainik basti Nagaur   (iii). Address2 : NIL   (iv). State : Rajasthan   (v). District : Nagaur   (vi). Pin : 341001   (vii). Landmark : Near sugan singh circle   (viii). Email address : petrolpumpproposalsfcaiocl@yahoo.co.in   (ix). Landline Telephone No. : 141-2601234   (x). Fax No. : 141-   (xi). Mobile No. : 9414040298   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Central PSU
A-3. Details of Person Making Application
  (i). First Name: GAURAV   (ii). Middle Name: NIL   (iii). Last Name: KUMAR   (iv). Gender: Male   (v). Designation: SENIOR MANAGER   (vi). Address 1: SHASTRI NAGAR AJMER   (vii). Address 2: NIL   (viii). State: Rajasthan   (ix). District: Nagaur   (x). Tehsil: NIL   (xi). Pin: 341001   (xii). Landmark: NEAR GOVT HOSPITAL   (xiii). Email Address: petrolpumpproposalsfcaiocl@yahoo.co.in   (xiv). Landline Telephone No.: 143-2601234   (xv). Fax No.: NIL   (xvi). Mobile No.: 6350612424   (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
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
1ApprovedFP/RJ/ROAD/21814/2016FP/RJ/ROAD/21814/20160.1220.12214 Mar 201701 May 2017
2ApprovedFP/RJ/ROAD/42922/2019FP/RJ/ROAD/42922/20190.2010.20131 Jan 202002 Jul 2020
3InprincipleFP/RJ/ROAD/26589/2017FP/RJ/ROAD/26589/20170.16460.164627 Aug 2020
Total 0.4876 0.4876
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.Nagaur Territorial0.18870.2145
Total0.18870.2145
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Nagaur0.18870.2145
Total0.18870.2145
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Shubhdand0.18870.2145
Total 0.1887 0.2145
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Left hand side Deceleration Lane0.08660.0285
2Right Hand Side Acceleration Lane0.08110.0285
3Front Side Service land0.0210
4Outlet Area00.1575
Total 0.1887 0.2145
C. Maps of forest land proposed to be diverted
Division 1. : Nagaur Territorial
  (i). Area of forest land proposed to be diverted(in ha.) : 0.1887   (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).
1.0.0866    View File
2.0.0811    View File
3.0.021    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: ROW DECLARED PROTECTED FOREST STRIP
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
1application to nodal officer Jaipur
2Check list 7 forest land detail
3Check list 8 Non forest land detail
4Check list 9 Justification of project
5Check list 10 Minimum use of forest
6Undertaking for CA cost
7Undertaking for NPV cost
8Undertaking for Addit NPV cost
9Area Calculation Sheet
10Technical report
11Undertaking for maintenance cost
12Undertaking for Muck disposal
13Undertaking no retail between two in 1 km
14Undertaking No material use from forest
15SOI Map of Site
16DGPS Map
17Conversion order for land
18FRA certificate
19Gazette notification forest merta ren road
20Jamabandi Land shubhdand
21Map land revenue
22LOI
23Land Registry
24NHAI NOC
25POI IOCL Gaurav Kumar
26Forest area calculation map
27NHAI Approved layout plan revised
28Gram Panchyat NOC
29Bar Chart revised after EDS
30SOI Toposheet Map 50000 Scale new
31Khasra map marking
32EDS reply
33BAR CHART
34Details of Permanent Employment to be Generated
35UNDERTAKING FOR HIGH TENSION LINE
36UNDERTAKING FOR LP GAS GODOWN
37UNDERTAKING FOR SITE SELECTION AND DISTANCE BETWEEN RETAIL OUTLET ON EITHER SIDE
38Revised Layout plan
39Pollution Certificate