NATIONAL AFFORESTATION & ECO-DEVELOPMENT BOARD

National Afforestation & Eco-Development Board

7th Floor, Paryavaran Bhawan

CGO Complex, Lodhi Road

New Delhi - 110 003.

Application for Grants-In-Aid during the 10^thPlan period

General Instructions:

1. Please fill in all columns.

2. If space under any column seems insufficient, separate sheet may be attached; but gist of what you want to say should be given in the space provided.

3. Along with the application please enclose the requisite documents as stated in the guidelines of the scheme.

Part I: General

Name and postal address of the Agency/ Applicant Organisation:

Name of the Post Office with PIN code:

Name of the Police Station (with reference to the Organisation’s address):

2. Telephone No. with STD code: -------------------- Fax No.: -------------------

3. Telegraphic Address: -------------------

4.1 Name and designation of Chief Functionary:

Telephone No.with STD code:

Name and designation of other Members of the Executive Body:

5. Status of Organisation (tick): Cooperative, voluntary Agency, Registered Society, Trust, Any other (Specify):

Registration number and Date and Place of Registration:

Name of the Registering authority and its address:

7. TITLE OF THE PROJECT FOR WHICH GRANT IS SOUGHT:

8. OBJECTIVES OF THE PROJECT (in brief):

9. IMPLEMENTATION OF THE PROJECT (Explain in brief how the project will be implemented with special reference to the following points. In case any of them is not applicable, please write `N.A.'):

9.1 Identification of Land (Please indicate soil type and the present land use):

9.2 Soil working and Treatment (Please indicate land development measures - leveling, contouring, ploughing, soil treatment with gypsum, etc. - proposed):

9.3.1 Scientific and common names of species proposed to be raised/planted and their number/proportion:

9.3.2 Plan for nursery raising and tree planting (Please indicate rainy season; how long will seedlings be kept in nursery, how and when will these be transported and transplanted, maintenance measures proposed, etc.):

9.3.3 Soil & Moisture Conservation works (Please indicate details of the soil and moisture conservation measures proposed, if any, along with full justification therefor):

9.3.4 Protection measures proposed, with reference to column 13.1 indicating why social fencing will not suffice because the project is supposed to be implemented with people's participation and for their benefit:

9.5 Irrigation sources:

9.6 Extension and Training (Please indicate how the programme participants are proposed to be motivated/trained for various forestry activities/operations).

9.7 Who will provide technical assistance, if required, to the agency?

9.8 Organisation and management of work (Please give details of the organisational structure to implement the project especially at the field level);

Any other salient features of the project you may wish to highlight:

Present Bankers of the organization (Name and branch of the Bank along with its postal address, type of account and its identification number):

(NAEB may ascertain the financial standing and credibility from the Bank authorities during the processing of the proposal)

Part II: Land Data

10. STATUS OF LAND

10.1 STATE: DISTRICT:

BLOCK: TALUKA:

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VILLAGE/ LOCAL BODY AREA NUMBER OF

(Where work would be undertaken) (in hectares) BENEFICIARIES

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TOTAL

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* Local body/ Village-wise details of beneficiaries should be given separately

In case the number of locations exceeds 6, please attach a separate sheet of paper giving these details.

10.2 OWNERSHIP PATTERN:

AREA (HA) LOCATION

to be afforested (Name of Village/ (Khasra number etc)

local body)

Private land --------------- ------------------- -----------------------

Community land --------------- ------------------- -----------------------

Government Revenue land -------------- ------------------- -----------------------

Forest land -------------- ------------------- -----------------------

Any other (specify) --------------- ------------------- -----------------------

TOTAL ---------------

10.3 TYPE OF LAND TO BE TAKEN UP UNDER THE PROJECT;

AREA (Ha.)

Gullied and/or ravinous land --------------------

Undulating upland with or within scrub --------------------

Surface water logged land and marsh --------------------

Salt affected land --------------------

Shifting Cultivation Area --------------------

Degraded forest land --------------------

Strip lands --------------------

Sands --------------------

Mining/industrial wastelands --------------------

Marginally Cultivated land --------------------

TOTAL --------------------

10.4 NUMBER OF BENEFICIARIES AND OTHER CATEGORIES;

A) Total Number of Beneficiaries* -----------------------------

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B) CATEGORY NO. OF BENEFICIARIES

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SCHEDULED CASTE (SC)

SCHEDULED TRIBE (ST)

MARGINAL FARMERS (MF)

SMALL FARMERS (SF)

LANDLESS (LL)

WOMEN (W)

OTHER (SPECIFY) (O)

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*Caution - The sum of total of the categories will not be the same as mentioned at 'A' as the categories are overlapping.

Part III: Physical / Financial

11.1 DURATION OF THE PROJECT FROM ------------- TO --------------

(The period should be at least of 3 year duration)

11.2 PHYSICAL TARGETS OF THE PROJECT (YEAR-WISE):

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ACTIVITY Year-1 Year-2 Year-3 Total

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A. NURSERY

Number of Nurseries

Number of Seedling

to be raised:

B. PLANTING

Seedlings to be planted:

Public lands (area in ha)

Number of seedlings

Private lands (area in ha)

Number of seedlings

C. AWARENESS RAISING/EXTENSION/

Training etc. activities

Number of camps/ workshops etc.

Number of persons

D. PROTECTION MEASURES

Public lands only (area in ha)

E. SOIL & WATER CONSERVATION MEASURES

Public lands (area in ha)

Private Land (area in ha)

Forest lands (area in ha)

F. TRANSPORTATION OF SEEDLINGS

(Hill and Desert areas only)

Number of seedlings to be

Transported

G. ANY OTHER (SPECIFY)

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12.A. PHASING OF FINANCIAL ASSISTANCE SOUGHT

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AMOUNT IN Rs.

ACTIVITY Year-1 Year-2 Year-3 Total

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A. NURSERY

@ Rs. -------/seedling

B. PLANTING

Public lands

@ Rs. -------/seedling/ha*

Private lands

@ Rs. -------/seedling/ha*

Forest lands

@ Rs--------/seedlings/ha*

C. SOIL & WATER CONSERVATION MEASURES

Public lands

@ Rs. --------/seedling/ha*

Private lands

@ Rs..--------/seedling/ha*

D. OVERHEADS

Upto 10% of the cost of A+B+C

E. AWARENESS RAISING/EXTENSION/

TRAINING etc.

Upto 5% of the cost of A+B+C

F. PROTECTION MEASURES

(Public/Forest lands only)

@ Rs. --------/ha

G. TRANSPORTATION OF SEEDLINGS

(Hill and Desert area only)

@ Rs. --------/seedling/ha*

G. ANY OTHER (SPECIFY)

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TOTAL

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* Strike out whichever is not applicable.

12.B SOURCE OF FUNDS:

12.B.1 FINANCIAL ASSISTANCE REQUIRED FROM NAEB:

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ACTIVITY Amount in Rs.

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a) Nursery ------------

b) Planting ------------

c) Soil & Water Conservation Measures ------------

d) Overheads ------------

e) Awareness raising ------------

f) Protection Measures ------------

g) Transportation of seedlings ------------

h) Any other (specify) ------------

Total ------------

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12.B.2 FROM OTHER SOURCES

a) Bank (specify name of the Bank) -----------

b) Any other Govt. Scheme (specify) -----------

c) Own funds of the Applicant Agency -----------

d) Other (specify) -----------

Total

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TOTAL PROJECT COST (12.B.1+12.B.2)

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12.C. Please name the nearest place (convenient to the agency) alongwith district, which has a branch of Union Bank of India.

12.D If NAEB have sanctioned a Grant-in-Aid for other project(s) for this applicant agency in the past, details thereof including sanction number(s) and date(s):

Part IV: Protection, Usufruct/Benefits

13.1 Protection of plantations with special reference to the concept of Social Fencing:

13.2 Maintenance of Nursery and Plantations:

13.3 In case of community plantation, how will the produce be distributed?

13.4 In case of individual farmers, what benefits accrue?

13.5 If any other form of organisation to utilise the produce is being envisaged, please indicate;

Part V: Certificates

CERTIFIED THAT:

1. The above particulars are, to the best of our knowledge and belief, correct.

2. The beneficiaries belong to weaker sections of society / are below poverty line in case of nursery/planting on private lands.

3. We have not applied to/received from any other funding Agency aid for this project, except as at 12.B.2.

4. We shall abide by all the Terms and Conditions of the Grant.

5. We shall furnish such periodical/special reports as may be required by NAEB

6. Our books and records shall be open to inspection at all times to NAEB or their authorised representatives.

NAEB may, at their discretion, themselves or through their authorised representatives evaluate the physical progress/utilisation of funds for this project.

The undersigned shall be personally responsible for the credibility and authenticity of the information provided and documents attached with the proposal and legally liable for any default in this regard.

In the event of any default or deviation from the terms and conditions of sanction of the project, the Board shall have the right to recover the grant from the Agency.

Signatures, Names and Stamp

of Chief Functionary

of the Agency

Postal address:

Telephone Number with STD code:

* Name, designation and seal of the attesting official.

Part VI: Checklist Of Documents

Attested copies of the Registration Certificate, Memorandum of Association and Bye- laws of the Agency .

2. Attested copy of the Audited Statement of Accounts for the last three successive years.

A note on past activities especially those related to forestry or related social service sectors development.

A list of beneficiaries giving details of land for nursery raising/tree planting viz. survey/ khasra numbers, area in ha. and names of owners, Local body/ Village-wise. However, the Agency will have to certify on the list of beneficiaries that the Agency has obtained the consent of the beneficiaries concerned for nursery, planting and maintenance/ after care activities and the same is available in the Agency’s office for verification.

Written consent of owners of land that they have no objection to nursery/ afforestation activities being taken up on their lands. In case of private lands, the details at (iv) above will suffice. These details should be verified and authenticated by the concerned Revenue officials/ Village Councils (for N.E. region) and countersigned by the Member-Secretary of the concerned JFMC/ EDC or the concerned Forester/ Block Forest Officer.

A certificate from the agency that at least 50% of the beneficiaries are SC/ST or from disadvantaged sections of society. This may not be insisted upon where the SC/ST population is not sufficient to fulfill this stipulation. However, at least 50% of the total beneficiaries should be women. This should be countersigned by the concerned village panchayat/ village council/ local body.

A detailed note on the Agency's plan for nursery raising, soil & moisture conservation works, tree planting and also the details of its organisational structure to implement the project at the field level.

A certificate from the agency that at least 50% of the beneficiaries are SC/ST or from disadvantage section of the Society duly countersigned by the respective village panchayat.

Location map of the proposed area.

Details of land, Local Body/ Village-wise, indicating Khasra Nos./plot Nos. and area in ha. These details should be verified and authenticated by the concerned Revenue or Local Body officials/ Village Councils (for N.E. region) and countersigned by the Member-Secretary of the concerned JFMC/ EDC or the concerned Forester/ Block Forest Officer.

11. List of species proposed to be planted.

Part – VII: Cost Norms For Various Components

Sl.No	Item of Work	Approved Cost Norms
		For Govt./ Community land (1600 plants/ha.)	For Private land (1600 plants/ha.)	Pasture Development (400 plants/ha. + grasses)
1.	Nursery raising *	2700	2700	500
2.	Plantation (a) Advance Work (b) Plantation	5120 4000	2560 2800	1400 2000
3.	Soil & Moisture Conservation	1800	900	1110
	Sub-total	13620	8960	5010
4.	Overheads (upto 10% of sub-total)	1362	896	501
5,	Awareness raising (upto 5% of sub-total)	681	448	251
6.	Protection	1100	-	-
7.	Transportation (hilly and desert areas only)	200	200	-
	TOTAL	16963	10504	5762

* - includes the cost of 20% extra seedlings for casualty replacement.

Note: Deviation to a maximum of 20% be allowed to the implementing agency to utilise funds within activities relating to nursery raising, plantation, and soil and moisture conservation works with reference to the approved cost norms for an activity, depending on the nature of the project and justification for seeking such variation furnished by the implementing agency. at the project formulation stage. Deviation upto 5% of the indicated cost norms in these activities would be allowed during implementation stage. The total approved outlay for nursery raising, plantation, and soil and moisture conservation works for a project will, however, not be exceeded on account of allowing the above-mentioned variations.