Application for Clearance to Develop

PPA application form for clearance to develop private ports

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APPLICATION FOR CLEARANCE TO DEVELOP
APPLICANT PROFILE
Name of Applicant/Company:
Name of Authorized Representative:
Address 1 (Office Address)

Telephone Number 1:

Address 2 (Billing Address):

Telephone Number 1:

E-Mail Address:

Fax Number

Tax Identification Number (TIN)

SEC Registration Number

Business Type:

Single Proprietorship

Partnership

BDT No.
Corporation

Nature of Business:

PRIVATE PORT PROFILE
Port Facility/Structure to be Put-Up:

Wharf

Estimated Cost of Improvements to be Put-Up:
Location/Site of Private Port:

Barangay _____________________

Foreshore Lease Contract No.

Area size (in sq.m.)

Environmental Compliance Certificate (ECC) No.

Pier

Others

Intended use/purpose:
Municipality/City of

_________________________

TCT No. (Back-Up Area)
Duration/Term of Permit: No. Of Mos. ____

DOCUMENTARY CHECKLIST

No. Of Yrs. ______

VALIDATION FOR PPA USE ONLY

(Put () if submitted, (x) is not available)
Basic Requirements:

Filing Fee
Unified Application Form specifying the exact location of the
foreshore area, area size in sq.m., intended use/purpose,

Date of Filing:

proposed structure to be put-up and estimated cost of

O.R. No.

improvements with Summary of Project Scope, Description
and Vicinity Map as attachments
Received by:
Duly Notarized Omnibus Undertaking (Sworn Affidavit)

Printed Name and Signature

Remarks:

Status as of _______________________

Approved

Denied

Pending