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Agricultural, Foreshore, Reclaimed Land or Miscellaneous Lease Application
DENR application form for agricultural, foreshore, reclaimed land or miscellaneous lease
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REPUBLIC OF THE PHILIPPINES
Department of Environment and Natural Resources
AGRICULTURAL, FORESHORE, RECLAIMED LAND
OR MISCELLANEOUS LEASE APPLICATION
The undersigned hereby makes application under the provisions of Chapters VI and IX of
Commonwealth Act 141, as amended, to lease for a period of ___________ years the tract of
land as described as follows:
situated in the Barrio of ______________, Municipality of _____________________ Province of
________________, Philippines, containing an area of _________________, the shape and
dimension of said tract being indicated in the sketch drawn on the back of the application.
2. My name is ____________, my age is ______ years; the place of my birth is
____________________, I am a citizen of ____________ and my post office address is
______________________; I am married, single, and the name of my wife/husband is
_________ who is a citizen of ___________ I am not employed in the government service. (If a
government employee, he should attach to this application permission in writing of the head of
the Department under which he is working). I possess funds and personal property as follows.
With which I expect to put into beneficial use the land applied for within the period fixed by law:
________________________________________________________- (If the applicant is a
corporation or association, attach a certified copy of the articles of incorporation or copartnership and evidence of its having been authorized to transact business in the Philippines.)
3. I have examined the land applied for, and it contains no improvement or indication of
occupation and settlement, except as follows:
_________________________________ and to the best of my knowledge and belief, it is
neither timber nor mineral land and contains no guano or any deposit of salts or coal.
The following improvements are proposed to be made on the land applied for, the same to be
used solely for ____________ purposes. (State kind and approximate value of proposed
improvements, such as houses, warehouses, factories, wharves, docks, piers, etc. (If the land will
be devoted for agricultural purposes, state the crop to be raised.)_____________________
4. This application is made in good faith for the exclusive benefit of the applicant and not either
directly or indirectly, for the benefit of any other person, corporation, association or
partnership, and for the actual purpose of using the land for the object specified in this
application and for no other purposes. I will not sell, assign, transfer, sublet or in any manner
encumber the land of the right or rights that I may acquire, without the approval of the
Secretary of Environment and Natural Resources first had been obtained as provided in Section
40 of Commonwealth Act 141, as amended.
5. I agree to defray all expenses that might be incurred in the survey of the land the applied for, in
advertisement of this application and other legal and necessary expenses and to deposit on
account thereof such amount as the Regional Executive Director may require, and to conform to
delimitation, classification, survey of the land herein applied for.
6. That I agree that a strip forty meters wide starting from the bank on each of any river or stream
that may be found on the land I applied for, shall be demarcated and preserved as permanent
timberland to be painted exclusively to trees of known economic value, and that I shall not
make any clearing thereon or utilize the same for ordinary farming purpose even after patent
shall have been issued to me or a contract of lease shall have been executed in my favor. (Note:
Not applicable if land applied for is for residential, industrial or commercial purposes)
7. I a ___________ a member, stockholder, officer, representative, attorney, agent, employee or
bondholder of the following corporations, associations or partnerships which are engaged in
agriculture and are holders of agricultural public lands in the Philippines.
8. I understand that this application conveys no right to me to enter upon, occupy, cultivate, or
make clearings on the land until the same has been finally approved and a lease contract
executed, and that any lease applicant who shall lawfully and knowingly submit false statements
or execute false affidavits in connection with the foregoing application shall be deemed guilty of
perjury and punished by a fine of not more than two thousand pesos and by imprisonment for
not more than five years, and in addition thereto his application shall be cancelled and all
amounts paid on account thereof forfeited to the government, and he shall not be entitled to
apply for any public land in the Philippines.
Signature of applicant