Application Form

HLURB application form for advertisement approval

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Housing and Land Use Regulatory Board
Expanded National Capital Region Field Office
6th Floor, Sunnymede IT Center,
1614 Quezon Avenue, South Triangle, Quezon City
Pursuant to Sections 19 of Presidential Decree No. 957,
as implemented by Board Resolution No, 921, Series of 2014
(to be accomplished in duplicate)
Pursuant to Section 19 of Presidential Decree No. 957 and its Implementing Rules and Regulations,
Memorandum Circulars and Guidelines, the undersigned hereby apply for approval of the proposed
advertisement of ___________________ owned and developed by ___________________________
which is due for publication / broadcasting/ distribution on _____________________.

Attached herewith are the following:
[ ] Two (2) copies of the proposed advertisement;
[ ] Copy of Certificate of Registration and License to Sell; and
If the person/entity advertising is an HLURB-registered broker, the following additional requirement
shall be submitted:
[ ] Copy of the Marketing Agreement and/or Authorization to Advertise
I can be reached at :
Address : _________________________________________________________________________
Telephone No. : __________________________________________
Or through my representative: ________________________________________________________
Address : _________________________________________________________________________
Telephone No. : __________________________________________
I hereby attest that all the foregoing information, data, and submitted documents are true and correct
to the best of my knowledge and have been given freely, voluntarily and without fraudulent or deceitful
intent and purpose whatsoever, and that I have personally read, filled-out, understood and signed the
foregoing application form.
Printed Name and Signature
______________________, _______________________

SUBSCRIBED AND SWORN to before me this _______ day of _________________, _______,
affiant exhibiting to me ____________________ issued in _____________ on __________________.

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