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08-1A Application for Industrial Sand and Gravel Permit (ISAG) - MGB

MGB application form for industrial sand and gravel permit

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Republic of the Philippines
PROVINCIAL/CITY MINING REGULATORY BOARD
Province/City of ________________

APPLICATION FOR
INDUSTRIAL SAND AND GRAVEL PERMIT (ISAG) NO. ______
________________, 19____
The Provincial Governor/City Mayor
Provincial/City Mining Regulatory Board
Province/City of ___________________
Sir:
In accordance with the provisions of the Philippine Mining Act of 1995 and
DENR Administrative Order No. 96-40, otherwise known as the Revised Implementing
Rules and Regulations, the undersigned _____________________ hereby applies for an
Industrial Sand and Gravel Permit to extract and dispose ____________________ cubic
meters of materials authorized hereunder from a tract of land bounded by the following:
POINT

LATITUDE

LONGITUDE

with an approximate area of __________________________ hectares.
The area applied for is in public and/or private land, lake, river, stream, creek or
other public waters (underline applicable term), located in the Sitio of
___________________, Barangay of _____________________, Municipality of
__________________________, Province of _________________________, Island of
_________________, Philippines.
The applicant: Name; _______________________________________________
Address ______________________________________________
O

In case of individual must be a citizen of the Philippines, of legal age,
___________________________________________________________
(indicate civil status and if married, give name and citizenship of spouse)

O

In the case of partnership or corporation, must be duly registered and
incorporated under the laws of, and authorized to transact business in the
Philippines, at least sixty per centum (60%) of the capital stock of this
partnership, corporation shall be owned and held by citizens of the
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MGB Form No. 08-1A

Philippines. A certified copy of the SEC Registration, Articles of
Partnership or Incorporation shall be submitted herewith.
Attached also are the following supporting papers:
O

Clearance, when required, from the Bureau of Public Works, Bureau of Public
Highways, National Power Corporation, National Irrigation Administration and/or
other government agencies, that the proposed excavations in the area applied for
will not adversely affect or cause damage to existing public and private
properties, multipurpose dams, reservoirs, seawalls, dikes, bridges, buildings,
highways and other infrastructures;

O

Written consent of owners of the private lands adjoining the area that may be
affected by excavations to be undertaken;

O

Commitment to secure Environmental Compliance Certificate (ECC) prior to
extraction.

The applicant binds himself/herself or itself to pay the amount of
__________________ (P ___________) covering the total fee for the materials applied
for, and to file a ______________ bond in the amount of _________________, (surety,
cash or personal) ( P______________); and to strictly and fully comply with all existing
laws, rules and regulations, orders, instructions, resolutions and ordinances governing the
filing and approval of application and the granting of the permits for the extraction and/or
disposition of the materials herein applied for. Failure to do so shall cause the
cancellation of the permit and the confiscation and forfeiture of the bond and all the
payments, if any, made by the permittee, in favor of the Government. This application is
made for the exclusive use and benefit of the applicant and not either directly or
indirectly, for the benefit of any other person, corporation, partnership, and for the sole
purpose of removing and disposing of the said materials in the manner stated above. All
the statements in this application shall be considered as integral part of the permit to be
issued to him.
The above statements are true and correct to my best knowledge and belief.
Very respectfully,
__________________________
(Applicant)
TIN ______________________

ACKNOWLEDGEMENT

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MGB Form No. 08-1A

Republic of the Philippines _____ )
Province of ________________ ) S. S.
City/Municipality of _________ )
SUBSCRIBED AND SWORN to before me at the place aforesaid, on this
__________ day of ____________________, 19_____. The affiant exhibited to me
his/her Community Tax Certificate No. ____________ issued at ___________ on the
___________ day of _______________, 19____.
___________________________
NOTARY PUBLIC
Until Dec. 31, 19 ______
PTR No. ____________
Doc. No.
Page No.
Book No.
Series of

_______
_______
_______
_______

INSTRUCTION
1.

This application shall be accomplished in quintuplicaate, two copies to be retained
by the applicant, the original to the Provincial/ City Mining Regulatory Board,
one copy to the Office of the Governor and the remaining copy to be forwarded to
the MGB Regional Office

2.

All pertinent information required shall be given, inapplicable word cancelled,
and all blanks shall be filled up.

3.

Application not accompanied with all the required documents shall not be
accepted.

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