A: Project Details: 1 Name of Agency: 2 Brief Description of Agency: (Only Experience relevant to plantation & landscaping) 3 Project Assigned: (Description of project location) 4 Objective of the project: 5 Budget of Project: (Detail Budget to be attached as annexture - Budget proposal must be in compliance with plantation SOR) 6 Project Leader: (Person responsible for execution of project) Name, Address & Contact Information 7 Length of the project: 8 Expected Employment to be generated (in Mandays) B. Site Specific Details: 9 Avg width available for Avenue Plantation: 10 Average width available for Median Plantation: 11 Approximate Ha for Plantation: 12 Natural Species Present in Area along the roads a b c d e f Name of Species Approximate No of Plants Available Average Girth (in cm) of Plants 13 Is there any possibility of Seed Plantation. (Yes/No) Page 1 of 6
14 Type of Soil Present in Areas along the Road. (If possible, please attach soil health report as annexure). 15 Species Planned for Median Plantation: (Multiple Species can be planted, specify species name & km planned) 16 Species Planned for 1st Row of Avenue Plantation: (Multiple Species can be planted, specify species name & km planned) 17 Species Planned for 2nd Row of Avenue Plantation: (Multiple Species can be planted, specify species name & km planned) 18 Species Planned for 3rd Row (if any) of Avenue Plantation: (Multiple Species can be planted, specify species name & km planned) 19 No of Plants per Km Planned: (As per guidelines) 20 Does above plants can be used for Sustainable Harvesting: (Yes/No) 21 If Yes above, then please describe the use in brief. ( What is the use?, When it can be used?, How it will be used?) B. Project Implementation Details: 22 Details of Source of Planting Materials: 23 Height of Planting Material (Species wise): 24 Type of Insecticide/pesticide/fungicide to be used: 25 Source of Insecticide/pesticide/fungicide to be used: 26 Type of fertilizer to be used: 27 Source of fertilizer to be used: 28 Irrigation methodolgies planned to be used during 5 Years: (Please describe in brief) 29 Type of tree guard to be used: (please attach sample photo as annexure) Page 2 of 6
20 Details of Sub agency to be employed (if any) - (NGO/SHG/Gram Panchayat etc) 31 Manual Labour to be engaged will be sourced from: C. Maintenance Schedule: (Inline with Guidelines for National Green Highways Policy 2015) 32 Year 1: 33 Year 2: Page 3 of 6
34 Year 3: 35 Year 4: Page 4 of 6
36 Year 5: Page 5 of 6
D. Post Project Plan: 37 Please describe plan after 5 years (if any). Is there any plan for fruit/flower/others harvest of tree harvest. 38 Potential Beneficiariary from above harvest. 39 Expected Income can be generated per plant per year for beneficiary. E. Innovation or Salient feature of project prosposal: 40 Please describe in brief if you are planning to use any innovating approach in 5 years. (either in planting, pitting,fencing, irrigation, weeding, maintenance etc). Any innovative approach will be vetted higher that others during evaluation, Notes: 1 Please attach proposed budget as annexure. As per guidelines 2 Please attach photos of different method to be used. (This will help us in evaluation the proposal) a. Plantation b. Pitting c. Irrigation d. Fencing 3 Please attach Soil health card. 4 Please attach photos of native plant species present in the area. Date: Place: Name of Agency: Page 6 of 6 (Name and Signature of Authorised Person from Agency)