COASTAL AQUACULTURE AUTHORITY

MINISTRY OF AGRICULTURE

Application for Registration of

Coastal Aquaculture Farm

Name ………………………………………………………………………………………………………………..

Address …………………………………………………………………………………………………………….

………………………………………………………………..…. Ph.: No.: ……………………………………..

Total Farm Area (in Ha.) …………………………………………………………………………………….

Water Spread Area (in Ha.) ……………………………………………………………………………….

Block ………………………………………………………………………………………………………………..

G.P. .......................................................................................................................
 CHECK LIST RECOMMENDATION OF AQUACULTURE
PROJECT BY THE STATE LEVEL COMMITTEE TO THE
AQUACULTURE AUTHORITY
__________________________________________________________________________
1) Application in the prescribed form :
2) Requisite fees with the application :

3) Detail project report submitted :

4) Location with respect to CRZ :

5) Mode of Culture :

6) Stocking density :
7) If 40 ha. and above Detail information on
impact of water curses
EMP & EIP require. in the vicinity

If 10 ha. but less than Impact in ground

40 ha. EIA statement Water quality
require.
Impact on drinking
Water Source

Impact on agricultural
activity

Impact on soil & soil

Salinisation

Waste Water treatment

8) Distance from adjacent farm (in m)s
9) Distance from nearest agriculture land
10) Distance from nearest human settlement (in m)
 SITE INSPECTION REPORT OF BRACKISH WATER FISH FARM
(Date of Inspection - / /20 )

1) Name of the farm :

2) Address of the farm : Mouza ……………………………….………………………
: J.L.No. ……………………………….……………………….
: Khatian No. …………………………….………………….
: Plot No. ………………………………….………………….
: Block …………………………………….……………………
: District ……...…………………….…………………………
3) Name of the Farmer :
4) Address of the Farmer : Vill.: …………………………………………………………..
: P.O.: ………………………………………………………….
: P.S.: …………………………………………………………..
: Block: ………………………………………………………..
: Dist.: ………………………..………………………………
: Pin No.: …………………………………………………….
: Phone No.: ……………………………………………….
5) Total Farm Area (in Ha.) :
6) Water Spread Area (in Ha.) :
7) No. of tanks & water spread area of each :
8) Approx distance from the sea & creek :
9) Approx distance from the metal road :
10) Nature of the ownership :
11) Whether the farm affects the agriculture
practice in the vicinity :
12) Whether culture have already been started :
13) Type of culture :
14) Rate of stocking of seed procurement centre,
time of liberation, days of culture :
15) Expected yield per ha.
16) What type of feed using & F.C.R. :
17) Is there any mangrove area by the side of farm :
18) Whether the local people benefitted by the fish
farm :
19) Classification of the land as per record :
20) Present physical status of the land :
21) Remarks if any :

Submitted to the Assistant Director of Fisheries, Brackish Water, North 24 Parganas for favour of
information and necessary action.

(Signature of the Fishery Extension Officer)

 FORM – 1
COASTAL AQUACULTURE AUTHORITY
MINISTRY OF AGRICULTURE
1) Name of the Applicant (s) / registered
Company / Establishment (in BLOCK
LETTERS) with permanent address :

2) Address for Communication (in

BLOCK LETTERS) :

3) Whether the application is for

a) Registration of Aquaculture farm already
in operation in coastal area :
b) Registration of new aquaculture farm to
be constructed :

4) Details of land for which registration

is applied for
a) State :
b) District :
c) Taluk / Mandal
d) Revenue Village :
e) Survey number :
f) Ownership right (Whether freehold or
lease hold) :
g) Total Farm Area (in hectare) :
h) Water spread area (in hectare) :

5) If the Whole or a part of the above land

Falls under any one of the following
Categories please furnish details

Category Village Survey Number Extent (in ha)

a) Agricultural land
b) Forest Land
c) Land for village
common purpose
d) Land meant for
Public purpose
e) Wet land
f) Mangroves
g) Salt pan
6) Indicate the distance of unit site from
a) High tide line :
b) Nearest drinking water source :
c) Agricultural land :
d) Mangrove :
e) Marine protected area :
f) Adjacent aquaculture farm :
g) Human settlement (indicate the population
of the settlement) :
h) National Parks :
i) Sanctuaries :
j) Reserve forests :
k) Breeding, spawning ground and
other aquatic life :
l) Beaches :
m) Coral reefs :
n) Heritage area :

7) Water source for the aquaculture Unit

a) Sea : Yes / No
b) Creek / estuary / canal / back water : Yes / No
c) If the water source is as mentioned in (b)
above, indicate the name of source :

8) Date of commencement of operations

of existing aquaculture farm :

9)* Furnish project report giving details with

sketch (to scale) of design and layout of the
aquaculture farm in operation / proposed
along with operational details, water intake
and waste water treatment facility. :

10)* Weather Environment Impact Assessment

(EIA) / Environment Management Plan (EMP)
were carried out on the environment of the
aquaculture farm with reference to other land :
uses in its neighborhood and based on ope-
rational details of the unit as furnished in the
project report, please state specifically
whether.
 a) The Aquaculture activity has the effect of
causing water logging of adjacent area of
polluting the drinking water source :

b) By use of supplementary feeds/medicines/

drugs etc. will consequently increase Sediment-
tation which will be harmful to the environment :

c) Such activity would cause siltation, turbidity

with detrimental implecation on local fauna and
flora :

11)* If, Environment Impact Assessment (EIA)

has been done, please attach the report :

12)* If, Environment Impact Management Plan (EMP)

has been drawn up, please furnished details :

13)* If, Effluent Treatment System (ETS) has been in

Operation / proposed, please furnished layout,
design and technical details :

14)* Details of remittance of processing fees : Rs.-

No.-
Date-
Declaration
I / We ___________________________________________________________________ son (s) /
daughter (s) / wife of ______________________________________________________ residing
at ______________________________________________________________________ hereby
declare that the information furnished above is true to the best of my / our knowledge and
belief. I am / we are fully aware that if it is found that the information furnished by me / us is
false or there is any kind of deviation, violation of the condition on which certificate of
registration may be issued by the Authority, the certificate of Registration issued may be either
suspended or cancelled.

Date:
Place:
Signature of the applicant (s)

*Applicable for farms with water spread area of more than 2 (two) hectares.
 Declaration

I / We _________________________________________________________ son (s)

/ daughter (s) / wife of __________________________________________ residing
at ____________________________________________________________ hereby
declare that the information furnished above is true to the best of my / our
knowledge and belief. The Shrimp culture operation carried out by me / us had not
neither polluted the environment not damaged the ecology of the adjacent area. I
am / we are fully aware that if it is found that the information furnished by me /
us is false or there is any kind of deviation / violation of the condition on which
certificate of registration was granted by the Authority, the authorization /
renewal granted to me / us may be either suspended or cancelled.

Date:
Place:

Signature of the applicant (s)

 N

SITE MAP

W E

Total Farm Area (in ha.) :

Water Spread Area (in ha.) :
Mouza :
Khatian :
Plot No. :

Signature of the farmer

 জলাশেয়র শংসাপ

িন িলিখত তপশীেলর জিম , মৗজা ..................................................................................

জ.এল. নং ............................. খিতয়ান নং .........................................................................

দাগ নং ..............................................................................................................................

আয়তন মাট ............................................................ শতক / একর, বতমােন জলাশয় এবং

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জল থােক।

তািরখ : ........................

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.............................. াম প ােয়ত ...................................... ক

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