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/TN/Others/42494/2019   (ii). Name of Project for which Forest Land is required : Establishment of New Government Medical College   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : For establishing New Government Medical college in Nilgiris district to provide tertiary and advanced medical care to the public of Nilgiri District and floating population of tourists.   (iv). State : Tamil Nadu   (v). Category of the Proposal : Others   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 44732   (viii). Area of forest land proposed for diversion(in ha.): 10.12   (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): 100
A-2. Details of User Agency
  (i). Name : HEALTH AND FAMILY WELFARE DEPARTMENT   (ii). Address1 : Joint Director of Haelth services,Government headquarters Hospital campus, Jail hill Road, OOTY   (iii). Address2 : NIL   (iv). State : Tamil Nadu   (v). District : The Nilgiris   (vi). Pin : 643001   (vii). Landmark : NIL   (viii). Email address : thenilgiris.jdhs@gmail.com   (ix). Landline Telephone No. : 423-2442712   (x). Fax No. : 423-   (xi). Mobile No. : 9444982680   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: JointDirector   (ii). Middle Name: NIL   (iii). Last Name: HealthServices   (iv). Gender: Male   (v). Designation: Joint Director of Health Servi   (vi). Address 1: JDHS Office, Government Headquarters Hospital Campus, Jail Hill Road, OOTY   (vii). Address 2: NIL   (viii). State: Tamil Nadu   (ix). District: The Nilgiris   (x). Tehsil: Udhagamandalam   (xi). Pin: 643001   (xii). Landmark: NIL   (xiii). Email Address: thenilgiris.jdhs@gmail.com   (xiv). Landline Telephone No.: 423-2442712   (xv). Fax No.: NIL   (xvi). Mobile No.: 9444982680   (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.Nilgiris North10.120
Total10.120
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.The Nilgiris10.120
Total10.120
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
NIL
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Hospital1.57160
2Mortuary0.0440
3Laundry0.04150
4Cafeteria0.03020
5Kitchen0.02660
6Admin Block0.04510
7Toilet0.00540
8Ambulance Shed0.00260
9HT Panel Room0.0210
10RMO & ARMO office0.01850
11Preclinical labs0.15390
12Paraclinical labs0.15390
13Infectious disaeases ward0.06920
Total 2.1835 0
C. Maps of forest land proposed to be diverted
Division 1. : Nilgiris North
  (i). Area of forest land proposed to be diverted(in ha.) : 10.12   (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.
1.10.12    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): 300   (iii). Temporary Employment(Number of person-days): 54750
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?: Yes   (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 ?: No   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Salem
  (a). Village: Kurichi   (b). Area(in ha.): 20.24   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 72/6   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
  (v). Scanned copy of the map of the land identified for creation of Compensatory Afforestation prepared by using GPS ot Total Station:   (vi). Copy of Survey of India Toposheet in 1:50,000 scale indicating location of the land identified for creation of Compensatory Afforestation:
Additional information Details
Documents
S.No Documents
Remarks
1Authenticated Justification
2Certificate of No Violation of Forest Conservation Act.
3Certificate of demand for forest land
4Certificate to bear the cost and maintainence if Compensatory Afforestation
5Undertaking to pay the amount of NPV
6Undertaking to bear the additional NPV
7Undertaking to bear the cost of felling and transportation of trees
8Undertaking to pay the annual lease rent
9Surveyed sketch of outer boundary of proposed land to be diverted
10Clarification for NOC
11Scanned copy of the map
12Component wise breaup of the land
13Kurichi Survey of india Toposheet
14Kurichi Map of the land identified using DGPS total station
15Clarification on Survey of India Toposketch and Scanned copy of map prepared using total station
16Clarification by the Collector on NOC
17Undertaking for non occupancy of existing buildings of HPF in proposed land
18Covering letter for clarification sought from MoEFCC
19Revised Component wise breakup sketch of the proposed land.