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08-7 Application for Gemstone Gathering Permit
MGB quarry application form for gemstone gathering permit
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Republic of the Philippines
PROVINCIAL/CITY MINING REGULATORY BOARD (P/CMRB)
Province/City of ________________
APPLICATION FOR GEMSTONE GATHERING PERMIT
Application No. ________________
Date Filed _____________________
Applicant _____________________________________________________________
Address ______________________________________________________________
Married to _____________________________________________________________
Citizenship ____________________________________________________________
Total Area _____________________________________________________________
Sitio ____________________________ Barangay ____________________________
Municipality ______________________ Province _____________________________
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 Gemstone Gathering Permit for the removal of gemstone for commercial
purposes, to wit:
1.
The application fee of _____________________ and the verification fee of
________________ have been paid under Official Receipt No. ______________
dated __________________, _______________________, Philippines.
2.
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,
partnership or association.
3.
The applicant agrees to submit additional requirements should the Provincial/City
Mining Regulatory Board deem it necessary for purposes of determining his/her
qualifications for the grant of Permit applied for.
4.
The applicant agrees that the statements made in the application or made later in
support thereof, 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
omissions 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.
5.
The foregoing statements are hereby certified to be true to the best of the
applicants knowledge and belief.
___________________________
Applicant
TIN _______________________
MGB Form No. 08-7
ACKNOWLEDGEMENT
Republic of the Philippines
)
Province of _______________ )s.s.
City/Municipality __________ )
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.
