FORM - B
Form for seeking prior approval under Section-2 of the proposals by the State Governments and other authorities, in respect of renewal of leases,
which have been earlier granted clearance under Forest (Conservation) Act,1980
PART - I
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/GJ/Others/28992/2017   (ii). Name of Project for which Forest Land is required : Conveyor Corridor for Lakhpat Cement Works   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Proposal for diversion of 2.6564Ha. of Forest land, falling within conveyor alignment between proposed Limestone Mine and Clinkerisation plant at villages Maldo & Mudhvay and between Clinkerisation plant and Berthing Jetty in Kori Creek at village Kapurasi and Koriyani of Adani Cementation Ltd   (iv). State : Gujarat   (v). Category of the Proposal : Others   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 13300   (viii). Area of forest land proposed for diversion(in ha.): 2.6564   (ix). Non-forest land required for this project(in ha.): 5.4087   (x). Total period for which the forest land is proposed to be diverted(in years): 50
A-2. Details of User Agency
  (i). Name : ADANI CEMENTATION LIMITED   (ii). Address1 : Adani House, 56 Srimali Society, Navrangpura   (iii). Address2 : Ahmedabad   (iv). State : Gujarat   (v). District : Ahmedabad   (vi). Pin : 380009   (vii). Landmarks : NIL   (viii). Email address : sanjay.prasad@adani.com   (ix). Landline Telephone No. : 25558623   (x). Fax No. : 25557401   (xi). Mobile No. : 8094016218   (xii). Website (if any) : NIL   (xiii). Details of Proposals seeking prior approval of Central Government under the Act for diversion of forest land submitted by the User Agency 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
  (xiv). Legal status of User Agency : Private
A-3. Details of Person Making Application
  (i). First Name: Sanjay   (ii). Middle Name: NIL   (iii). Last Name: Prasad   (iv). Gender: Male   (v). Designation: AGM   (vi). Address 1: Adani Cementation Limited, Ground Floor, South Wing, Adani Coporate House   (vii). Address 2: Shantigram, S.G. Highway, Ahmedabad   (viii). State: Gujarat   (ix). District: Ahmedabad   (x). Tehsil: NIL   (xi). Pin: 382421   (xii). Landmarks: NIL   (xiii). Email Address: sanjay.prasad@adani.com   (xiv). Landline Telephone No.: 25558623   (xv). Fax No.: 07925557401   (xvi). Mobile No.: 8094016218   (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:
A-7. Details of the forest land returned back to the State Forest Department or any other Authority from the forest land diverted in favour of the user agency
A-9. Details of Transfer of Lease
Serial No Name of person Address of person Date of transfer MMDR File Transfer Deed Conservation MoEF_file No Date of approval MoEF file
NIL
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
  (i). Whether any proposal seeking prior approval of Central Government under the Act for diversion of forest land required for the project has been submitted in the past?. : No
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.Kutch-West2.65645.4087
Total2.65645.4087
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.kutch2.65645.4087
Total2.65645.4087
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Maldo0.60620
2Kapurashi2.05020
3Mudhvay01.7235
4Kapurasi01.71
5Koriyani01.9752
2.6564 5.4087
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Kapurashi Forest Land2.05020
2Maldo Forest Land0.60619920
3Koriyani Govt. Land01.2744
4Koriyani Private Land00.7008
5Mudhvay Gauchar Land01.7235
6Kapurashi Private Land01.71
Total 2.6563992 5.4087
C. Maps of forest land proposed to be diverted
Division 1. : Kutch-West
  (i). Area of forest land proposed to be diverted(in ha.) : 2.6564   (ii).Shape of forest land proposed to be diverted : Linear   (b). No. of Segments : Four
Segments wise details
Segmenst Segment Area(in ha.) Kml File of SegmentsTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.0.6443    View File
2.0.468    View File
3.0.9379    View File
4.0.6062    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 DGPS 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 ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 5   (iii). Temporary Employment(Number of person-days): 15
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?: Yes   (a). Copy of Cost-Benefit analysis:
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : Yes   (a). Status of the Environmental Clearance to the Project: EC under process   (ii). Environmental Clearance File No.: IA-J-11011/494/2017-IA-II(I)
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. : kutch
  (a). Village: khengarpar   (b). Area(in ha.): 2.6564   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 4p   (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 DGPS 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
1Certificate: Undertaking
2Certificate: Project Are Laying Within or Outside ST Area
3Certificate: Archaeological Importance
4Certificate: Tree Felling
5Certificate: Certificate of CA Cost
6Certificate: NPV
7Certificate: Cost of Felling Tree
8Certificate: No Violation of FCA 1980
9Certificate: Minimum Demand Certificate of Forest Area
10Certificate: Estimated Project Cost
11Certificate: Employment Likely to be Generated
12CA Land Suitability Certificate
13Scheme of CA Land
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