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08-3 Application for Quarry Permit
MGB application form for quarry permit
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: MGB Form No. 08-3
Republic of the Philippines
PROVINCIAL/CITY MINING REGULATORY BOARD (P/CMRB)
Province/City of ________________
APPLICATION FOR QUARRY PERMIT
Application No. __________________________
Date Filed __________________
Applicant
__________________________________________________________
Address
__________________________________________________________
Size of Applied Area (hectares)_____________________________________________
Quarry Resources to be extracted/disposed __________________________________
Quantity ______________________________________________________________
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 the
Revised Implementing Rules and Regulations promulgated thereunder, the undersigned
____________________________, for and in behalf of _______________________,
hereby applies for a permit to extract and dispose ___________________ materials from
a tract of land situated in Sitio _________________, Barangay ___________________,
Municipality of _______________________, Province of ___________________, Island
of _________________, and bounded by:
On the North: ______________________________
On the East:
______________________________
On the South: ______________________________
On the West: ______________________________
with an approximate area of __________________________ hectares.
1.
The application fee of _________________________ has been paid under
Official Receipt No. ________________ dated ________________________,
Philippines.
2.
The applicant agrees that the statements made in this application or made later in
support hereof, shall be considered as conditions and essential parts of the Permit
that may be granted by virtue thereof, and any falsehood in these statements or
omission of facts which may later change, or affect substantially the facts set forth
in said statements shall be sufficient cause for the cancellation of the permit
granted.
3.
This application is filed for the exclusive use and benefit of the applicant, and not
either directly or indirectly for the benefit of any other person, corporation or
partnership and the area is applied for the sole purpose of its development and
operation, and for speculation.
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MGB Form No. 08-3
4.
The foregoing statements are hereby certified to be true to the best of the
applicant's knowledge and belief.
I, __________________________, the person executing this affidavit for this
application, being first duly sworn, depose and say: that I have read or have caused the
foregoing application read to me; that I thoroughly understand the same; that each and
every statement in this application is true and correct.
___________________________
Applicant
TIN _______________________
ACKNOWLEDGEMENT
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 quintuplicate, two copies to be retained
by the applicant, the original and one copy to be forwarded to the Provincial/City
Mining Regulatory Board, and the remaining copy for the files of the MGB
Regional Office.
2.
All pertinent information required shall be given, inapplicable word canceled, and
all blanks shall be filled up.
3.
Application not accompanied with all the required documents shall not be
accepted.
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