राष्ट्रीय पार्क/अभयारण्यों में गैर-वन गतिविधियों के लिए प्रस्तावों का प्रोफार्मा

Page 1 of 1

FORMS

(All documents to be submitted in triplicate and signed in Blue ink)

Page 2 of 2

PART - I

Proposal for Investigation and Survey in the National Park / Sanctuary

(Details to be provided by the Applicant)

1. Name of the Organization

2. Aims and Objectives of the Proposed Project

3. Location and Map (1:150000 scale) of the area duly authenticated by the competent authority to be investigated/ surveyed

4. Whether investigation/survey requires clearing of vegetation

5. If yes, please specify the extent (in Ha.)

6. Opinion of the Officer In Charge of the N.P./ WLS (Attach signed copy)

7. Opinion of the Chief Wild Life Warden (Attach signed copy). The following be included in the opinion:

i) Brief history of the Protected Area ii) Current status of Wildlife iii) Current status of pressures on protected Areas. iv) Projected impacts of projects on wildlife, habitat management and access/ use of resource by various stakeholders. v) Contiguous wildlife areas which would benefit wildlife if added to National park/Sanctuary. vi) Other areas in the State which have been recommended by State Government, Wildlife Institute of India, BNHS, SACON, IISC, IUCN or other expert body for inclusion in Protected Area network.

Signed

Signed

Signed

Project Head
The Officer In Charge of the N.P./ WLS

The CWLW Name

Office Seal

Office Seal Organization

Page 3 of 3 Date of submission to Govt. of India by the CWLW --

PART –II

(To be filled in by the Applicant)

1 Project details:

(i) Copy of the Investigation and Survey report.

(The report should include the dates of survey and the names of the investigators, surveyors and all officials of the concerned NP/ WLS who remained present during the period.)

(ii) Self contained and factual project report for which NP/WLS area is required

(Enclose copy of the Project Appraisal document)

(iii) Map (Duly authenticated by the Divisional / District Head of the Department dealing with Forests and Wild Life) on a scale of 1: 150000 showing the boundaries of the NP/WLS, delineating the area in question in red color).

(iv) Self contained and factual report of at least two alternatives considered by the project authorities along with technical and financial justification for opting national park/ sanctuary area.

(v) Copy of the Bio diversity Impact Assessment report in case the proposal involves diversion of more than 50 ha. NP/WLS area.

2 Location of the project/Scheme

(i) State/Union Territory (ii) District (iii) Name of the National Park/ Sanctuary

3 Details of the area required (in Hectares only)

(Provide break up of the land use under the project e.g., construction of dam, submergence, housing for staff, road etc)

Page 4 of 4 4 Details of displacement of people, if any, due to the project

(i) Total number of families involved in displacement (ii) Number of Scheduled Caste/Schedule Tribe families involved in displacement (iii) Detailed rehabilitation plan

5 Any other information relevant to the proposal but not covered in any of the columns above.

Signed by

Project Head Name
Organization

Date of submission to the Head of the National Park / Sanctuary

Page 5 of 5

PART –III

(To be completed by the Officer –in- Charge of the National Park/ Sanctuary completed and submitted to the Chief Wild Life Warden or officer authorized by him in this behalf within 30 days of the receipt of PART - II)

111
Date of receipt of the PART – II

222
Total Area (Ha.) of National Park/Sanctuary

333
Total area (Ha.) diverted from the NP/WLS so far for development
purposes

444
List the past projects and the area (Ha.) diverted

Name of Project Area diverted

Year of diversion

555 Positive impact/s due to the diversion of area for the projects referred
to in column 4 above

Name of the Project /s Positive impact

Scientific Basis of Assessment

(Attach separate document, if required)

666
Negative impact/s due to the diversion of area for the projects referred
to in column 4 above

Name of the Project /s Negative impact
Scientific Basis of Assessment

(attach separate document, if required)

777
Management Plan Period

Attach copy of the Management Plan/Management Scheme/ Recommendation of Chief Wildlife Warden

Page 6 of 6 888
List Management actions taken/ proposed to be taken in the whole
Block/ Zone in which the proposed area is located.

999
Type of forest in which the proposed area falls.

111000 Location of the proposed area w.r.t. the critical/intensive wildlife management areas/ wildlife habitats. (attach Map to scale)

111111 List the likely POSITIVE AND NEGATIVE impact/s of the proposed project giving scientific and technical justification for each impact.

111222 Provide COMPREHENSIVE details of the impact of the proposal in
terms of Sections 29 and/or section 35 (6) of the Wild Life
(Protection) Act, 1972 as the case may be.

111333 Whether the project authorities have ever committed violation of the
Wild Life (Protection) Act, 1972 or Forest Conservation Act, 1980. If yes, provide the EXHAUSTIVE details of the offence and the present status of the case.

(Concealing or misrepresenting the facts will lead to rejection of the case in addition to any other penalty as prescribed under Law)

111444 Have you examined the Project Appraisal document and the
alternatives as provided in PART – II.

15. Have you examined the Bio diversity Impact Assessment Report.

16 If Yes, please give your comments on the recommendations given in
the report

17 Dates and duration of your field visits to the proposed site

18 Do you agree that the present proposal of diversion of NP/WLS area
is the best or only option and is viable.

19 Any other information that you would bring to the notice of the State

Page 7 of 7 Board, National Board or its Committee that may be relevant and assist in decision making

20 Do you recommend the project.

(Please provide full justification to support your recommendations)

Signed by

The Officer In Charge of the N.P./ WLS Official Seal

Date of submission to the Chief Wild Life Warden or any other officer authorized by him in this regard

Page 8 of 8

PART -IV

(To be completed by the Chief Wild Life Warden within 15 days of the receipt of PART – II and III)

1 Date of RECEIPT of PART II and III by the Chief Wild Life Warden or the officer authorized by him in this regard

2 Do you agree with the information and recommendations provided by the Officer – in – Charge in PART – III

3 If not, please provide the reasons

4 Have you visited the site yourself and held discussions with the applicant.

5 Do you agree that the present proposal for permitting use of NP/WLS area is the best option or only option and is viable.

6 Please provide specific comments w.r.t. Section 29 of the Wild Life
(Protection) Act, 1972

7 Any other information that you would bring to the notice of the State
Board, National Board or its Committee that may be relevant and assist in decision making

8 Do you recommend the project.

(Please provide full justification to support your recommendations)

9 Conditions, if any, to be ensured in the interest of wildlife for allowing use of the area.

Signed by

The Chief Wild Life Warden
Name State Official Seal

Date of submission to the State Government

Page 9 of 9

PART -V

( To be completed by the Department in Charge of Forestry and Wild Life in consultation with the State Board for Wild Life within 30 days of the receipt of PART – II, III and IV )

1 Date of RECEIPT of PART II, III and IV by the Department

2 Do you agree with the recommendation/s of the Chief Wild Life Warden

3 If not, please provide the reasons.

4 Did you provide PART II, III, and IV to the members of the State Board
for Wild Life

5 Attach copy of the opinion of the State Board for Wild Life

6 Give details of the recommendations of the State Government

Signed by

The Principal Secretary
Name State Official Seal

Date of submission to the Central Government