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/UK/ROAD/10700/2015   (ii). Name of Project for which Forest Land is required : CONSTRUCTION OF CHANDAK MAILA TADIGOWN MOTOR ROAD UNDER STATE SECTOR   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : CHANDAK TO MAILA TADIGOWN MOTOR ROAD   (iv). State : Uttarakhand   (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) : 50.4   (viii). Area of forest land proposed for diversion(in ha.): 1.935   (ix). Non-forest land required for this project(in ha.): 1.665   (x). Total period for which the forest land is proposed to be diverted(in years): NIL
A-2. Details of User Agency
  (i). Name : PUBLIC WORK DEPARTMENT   (ii). Address1 : PD PWD PITHORAGARH GHANTAKARAN DISTT PITHORAGARH 262501   (iii). Address2 : NIL   (iv). State : Uttarakhand   (v). District : Pithoragarh   (vi). Pin : 262501   (vii). Landmark : NEAR POST OFFICE   (viii). Email address : harishbathyal99@gmail.com   (ix). Landline Telephone No. : 5964-225115   (x). Fax No. : 5964-225115   (xi). Mobile No. : 9412144099   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Sunil   (ii). Middle Name: Kumar   (iii). Last Name: Kohali   (iv). Gender: Male   (v). Designation: EXECUTIVE ENGINEER   (vi). Address 1: PD PWD PITHORAGARH GHANTAKARAN DISTT PITHORAGARH 262501   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Pithoragarh   (x). Tehsil: Pithoragarh   (xi). Pin: 262501   (xii). Landmark: NEAR POST OFFICE   (xiii). Email Address: pwdpithoragarh@gmail.com   (xiv). Landline Telephone No.: 5964-225115   (xv). Fax No.: 05964225115   (xvi). Mobile No.: 9412144099   (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.Pithoragarh1.9351.665
Total1.9351.665
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Pithoragarh1.9351.665
Total1.9351.665
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.)
1MAILA, TADIGOWN1.9351.665
Total 1.935 1.665
C. Maps of forest land proposed to be diverted
Division 1. : Pithoragarh
  (i). Area of forest land proposed to be diverted(in ha.) : 1.935   (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).
1.1.935    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: Yes   (a). Copy of map indicating location of alternative examined:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: No
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. : Pithoragarh
  (a). Village: Maila   (b). Area(in ha.): 4   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 797,799,801,820,821   (e). Present owner: User Agency   (f). Copy of Ownership proof:
  (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
1Note containing justification for locating the Project in forest land (pdf file).
2Certificate by DM- Forest Right Act-2006(in MoEF revised prescribed form) (pdf file).
3Survey of India Toposheet in 1:50,000 scale indicating location of the land identified for creation of Compensatory Afforestation: signed by DFO (pdf file).
4Colored copy of the google map showing the land identified for CA. (kml file ) signed by DFO (pdf file).
5Administrative and Financial sanction (pdf file).
6Preliminary Joint Inspection report (by user agency, forest department, revenue department etc.) (pdf file).
7Comperative chart showing statement of both alignment or alternate site explored for the proposed project and reasons for their rejection duly countersigned by DFO. (pdf file).
8Certificate from the DM that no alternative suitable non-forest land is available for the project in question and the demand of the forest land for the project is barest minimum. (pdf file).
9Land schedule (for RF signed by DFO and civil soyam, Van panchayat and private nap land signed by DM). (pdf file)
10Category wise (RF,civil soyam, Van panchayat and private nap land, Notified forest land etc.) land length, width and area in Ha. (pdf file).
11Bar Chart with index (counter signed by DFO). (pdf file).
12Compensatory afforestation scheme in Civil and Soyam land (10 years) by DFO (pdf file).
13Certificate regarding suitability of indentified land for Comensatory Afforestation by DFO (pdf file).
14Undertaking by the User Agency to bear the cost of compensatory afforestation duly counter signed by the DFO (pdf file).
15Road side/gap filling plantation estimate (by DFO) (pdf file).
16Undertaking by the User Agency to bear the cost of Road side /gap filling plantation (by user agency) (pdf file)
17Details of the trees with their scientific name in RF, Civil Soyam, Van Panchayat, Private Notified land and in Nap Land should be mentioned (with valuation of the trees to be felled ) (0-10 dia trees will be mentioned as saplings). (pdf file) Tree count.
18Felling of Oak trees (if involves, inspection report of the concerning CF has to be provided). (pdf file).
19Certificate of felling minimum trees during the project work. (pdf file) .
20Muck disposal scheme (in prescribed format) (pdf file).
21Whather project area is a part of National Park or sanctuary and airal distance of the project from National Park or sanctuary signed by DFO. (pdf file).
22If the project area is within 10 Km radius of N/P or Centuary, Comments/No objection certificate of CCF Wild Life has to be provided. (pdf file) .
23No voilation has taken place, FC Act. 1980 reg. (pdf file).
24NOC from local Gram Sabhas. (pdf file).
25Certificate- work has not been started reg. (pdf file).
26Geologist Report (Govt. approved Geologist). (pdf file).
27Task Force report.
28Certificate by user agency for complying the condition imposed in geologist report/Task force recommendation in hill areas (excluding drinding water.
29Certificate by user agency for complying the condition imposed in Standard Condition (pdf file).
30No historical/monumental or relegeous place will be effected certificate reg. (by DM/DFO) (pdf file).
31Undertakoing regarding no animal will be effected adversely by the project. (Pdf file).
32Undertading to provide alternative fuelwood, kerosene or LPG to labours involved in project. (Pdf file).
33Benefited villages/Families/Population Certificate. (pdf file).
34NPV calculation certificate as per Hon'ble Supreem court /MoEF orders by DFO (pdf file).
35Undertaking of payment of NPV, if Hon'ble Supreem Court increses the rates of NPV (by user agency) (pdf file).
36Cost of the forest land and lease rent certificate by DM. (pdf file).
37Certificate of Lease period by user agency. (pdf file)
38Demarcation of land to be diverted (pdf file).
39Certificate of air distance from wanya jiv abhyaran Askot
40If non-forest or Revenue forest land is required to be provided by User Agency? A Copy of ownership proof and No Objection Certificate (pdf file).
41Other formate