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Application Form
LLDA application form for shoreland survey service
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
TECHNICAL SERVICES REQUISITION FORM
FOR LAND SURVEYS
TECHNICAL SERVICES REQUESTED
[ ] AREA SURVEY [ ] VERIFICATION 12.50 M ELEVATION [ ] LOCATION PLAN [ ] CERTIFICATION
PURPOSE
DATE APPLIED:
TO BE FILLED UP BY APPLICANT
NAME OF APPLICANT
LOT/PSU NO.
ADDRESS
AREA
OWNER/AUTHORIZED REPRESENTATIVE
TELEPHONE NO./FAX NO./CEL NO.
NATURE OF DEVELOPMENT (RECLAMATION, OTHERS, PLS. SPECIFY)
LOCATION
OWNERSHIP
REQUESTED BY:
BARANGAY
[ ] CORPORATION
MUNICIPALITY
[ ] COOPERATIVE
PROVINCE
[ ] INDIVIDUAL
OWNER/REPRESENTATIVE
TO BE FILLED UP BY CPD
ASSESSMENT
TYPES OF SERVICES NEEDED
TSR. NO.
BASIS OF PAYMENT
AMOUNT IN PESOS
ASSESSED BY:
AMOUNT IN WORDS
TOTAL
DATE
APPROVED BY:
TO BE FILLED UP BY FINANCE
FINAL BILLING
PAYMENT
AMOUNT
S.A. NO.
DATE
BILLED BY:
ACCOUNTING SECTION
RECEIVED BY:
LLDA-CPD-Form 43
Issue Date: April 2015
O.R. NO.
DATE
AMOUNT
BALANCE
CASHIER
Issue No.: 01
