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Application Form
LLDA application form for shoreland development clearance permit
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: LAGUNA LAKE DEVELOPMENT AUTHORITY
National Ecology Center, East Avenue
Diliman, Quezon City
Tel. Nos.: 332-2346, 376-4039, 376-4072, 376-4049, 376-4061
APPLICATION FOR SHORELAND DEVELOPMENT CLEARANCE
APPLICANT'S INFORMATION
[ ] LGU
[ ] INDIVIDUAL
[ ] COOPERATIVE
[ ] PRIVATE COMPANY
NAME OF APPLICANT
BUSINESS ADDRESS
TELEPHONE NO.
FAX NO.
E-MAIL
FOR INDIVIDUAL APPLICANTS ONLY
AGE
CIVIL STATUS
CITIZENSHIP
PLACE OF BIRTH
CITIZENSHIP
NAME OF SP0USE (IF MARRIED)
DATE OF BIRTH
DATE OF BIRTH
PLACE OF BIRTH
RESIDENCE CERT. NO.
LOCATION/USE OF SHORELAND AREA
IS THE SHORELAND AREA APPLYING FOR TITLED? [ ] YES
[
] NO
IF YES:
LOCATION OF SHORELAND (COMPLETE ADDRESS)
APPROXIMATE GEOGRAPHIC COORDINATES
LOT OWNER
OCT NUMBER
DATE ISSUED
TOTAL AREA
TCT NUMBER
DATE ISSUED
ADJOINING/ADJACENT STREET
BARANGAY
TOWN/CITY
PROVINCE
APPROXIMATE AREA (IN SQUARE METERS)
NOTE:
SPECIFY TYPE OF DEVELOPMENT
IF NO:
SUBJECT TO ACTUAL VERIFICATION
PURPOSE OF APPLICATION/TYPE OF DEVELOPMENT
APPLICANT'S AUTHORIZED REPRESENTATIVE
NAME OF AUTHORIZED REPRESENTATIVE
BUSINESS ADDRESS
TELEPHONE NO.
FAX NO.
E-MAIL
I do hereby certify the information supplied are true and correct in my knowledge and belief. I
understand that the information contained herein shall be subject to verification and that my false
statements shall be ground for rejection of this application.
____________________________________
Name & Signature of the Authorized Representative
________________________________________
Name & Signature of the President/Owner
Date: _______________________
LLDA-CPD-Form 36
Date: _______________________
Issue Date: May 2015
Issue No.: 01
