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29-17 Annual Report of Small Scale Mining Permittee
MGB report form for small scale mining
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: MGB Form 29-17 (Series of 2000)
MGB Form 29-17 (Series of 2000)
Republic of the Philippines
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Mineral Economics Information and Publication Division
North Avenue, Diliman, Quezon City
ANNUAL REPORT OF SMALL SCALE MINING PERMITTEE
For the Report Year ____________
NAME OF COMPANY/LICENSE/PERMITTEE
ADDRESS (Mailing address):
PART 1 - MINE INFORMATION
SITE NAME
REGION
PROVINCE
MUNICIPALITY
Date of First Operation
Major Product (Enter only one major product per site)
Year:
Month:
MINING METHODS USED: (Enter only one mining method per block)
Change
Day:
MILLING METHODS USED: (Enter only one milling method per block)
1.
1.
2.
2.
3.
3.
Telephone Number: (Write only one telephone number and one local number)
Direct Line:
Local No.:
Fax No.:
E-mail Address:
NAME OF MANAGING OFFICIAL
POSITION
PART 2 - TOTAL PRODUCTION
UNIT
GROSS QUANTITY
GROSS VALUE (000)
AVERAGE GRADE
A. PRIMARY
P
B. BY-PRODUCTS
P
PART 3 - TOTAL EXPORT/LOCAL SALE
COUNTRY OF
GROSS VALUE
GROSS QTY
Pesos (000)
DESTINATION (Specify Unit Used)
AVERAGE
Dollars (000)
GRADE
A. PRIMARY
P
$
P
$
B. BY-PRODUCTS
PART 4 - EMPLOYMENT
Report number of persons who worked at the MINESITE during the payroll ending nearest 15th of each month indicated.
TYPE OF EMPLOYMENT
Jan - Mar
Apr - Jun
Jul - Sept
Oct - Dec
TOTAL
Jan - Mar
Apr - Jun
Jul - Sept
Oct - Dec
TOTAL
1. REGULARLY-PAID EMPLOYEES
1.1 Production Workers
a. Skilled
b. Laborer
1.2 Admin. Employees
1.3 Supervisory Employees
2. IRREGULARLY-PAID EMPLOYEES
2.1 Working Proprietors
2.2 Family Workers
3. OTHERS (not included above)
TOTAL (1 to 3)
MAN-HOURS WORKED BY PRODUCTION WORKERS
Page 1 of 4
MGB Form 29-17 (Series of 2000)
PART 5 - CAPITAL INVESTMENT
BOOK VALUE, As End of Report Year _____________
(Value in Thousand Pesos)
(for Equipment/machineries, infrastructures)
TYPE OF CAPITAL INVESTMENTS
1. Lands
2. Mining Rights
3. Exploration and Development
4. Mine & Mill Equipment/Machineries
5. Support Service Equipment/Machineries
6. Building and Civil Works
7. Office Equipment
8. Working Capital
9. Others (specify)
T O T A L (1 to 9)
PART 6 - PRODUCTION COST: COST OF USED MATERIALS AND SUPPLIES
Report the value of materials and supplies used during the report year. Include industrial and non-industrial costs incurred by this site in its operations. Allocate accounts to
headiing. Value in thousand pesos.
ITEMS
1. Grease and Lubricants
P
P
HAULING,
HANDLING &
STORAGE
P
P
Volume
P
P
Unit of Measure
(liter)
MINING
MILLING
ADMINISTRATION
TOTAL
P
P
P
P
2. Chemicals
3. Explosives
4. Spare Parts
5. Containers and Packing Materials
6. Lumber
7. Steel Balls
8. Non-Durable Tools
9. Others Not Included Above
TOTAL (1 to 9)
PART 7 - PRODUCTION COST: COST OF LABOR
Report number of persons who worked in or for this company, their basic salaries and wages, overtime pay and benefits for work done by regularly paid employees within the
report year, paid in cash and in kind prior to all deductions such as witholding tax, group insurance, union fees, etc. Value in thousand pesos.
P
P
P
EXTRA
EXTRA
BENEFITS
BENEFITS
PAID IN CASH
PAID IN KIND
P
P
P
TYPE OF REGULARLY-PAID
EMPLOYEES
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
Number of
Regularly Paid
Employees
1. MINING
SALARIES &
WAGES
OVERTIME PAY
SSS/GSIS
TOTAL
P
a. Skilled
b. Laborer
2. MILLING
a. Skilled
b. Laborer
3. Hauling, Handling & Storage
a. Skilled
b. Laborer
4. Administrative Workers
TOTAL (1 to 4)
PART 8 - PRODUCTION COSTS: COST OF FUELS AND UTILITIES
Report the value of fuel and utilities consumed during the report year. Allocate accounts according to heading. Value in thousand pesos.
1. COST OF FUELS (indicate if gas, gasoline, diesel oil, bunker oil, coal, etc)
Quantity
Unit of Measure
(liter)
TOTAL COST OF USED FUELS BY SOURCE
Mining
Hauling,
Handling &
Storage
Milling
Total
Administration
P
P
P
P
P
P
P
P
P
P
Page 2 of 4
MGB Form 29-17 (Series of 2000)
2. COST OF UTILITIES
Quantity
Unit of Measure
2.1 Water
Mining
Hauling,
Handling &
Storage
Milling
Total
Administration
Liter
a. Purchased
b. Generated (If pumped by
above fuels do not include in totals
2.2 Electricity
KWH
a. Purchased
b. Generated
b.1 By the above fuels
b.2 By Other Sources
3. Sold
TOTAL (2.1 + 2.2 + 3)
P
P
P
P
PART 9 - OPERATING EXPENSES AND OTHER CHARGES
Report the value of expenses of the MINESITE for the report year. Include industrial and non-industrial charges incurred in the operations. Value in thousand pesos.
1. OPERATING EXPENSES
1.1 Marketing Expense
1. Smelter Charges
P
2. Refinery Charges
4. Assaying & Analysis Charges
P
5. Other Marketing Expenses
3. Freight Charges (Excluding customs duties)
1.2 General & Administrative Expenses
SUB-TOTAL (1.1 - 1 TO 5)
1. Repair & Maintenance of Buildings and
equipment (Fees Paymentsby Others) those related
2. Insurance received (excluding
to employment)
3. Transportation Expense (outside of production
8. Cost of Assets Sold In The Same Condition
as Purchased
9. Donations and Contributions
P
10. Rentals Expense Outside of Those Paid
Under Taxes
11. Royalties Outside of Those Paid Under Taxes
and4. Telephone, Telegraph, Postage and Other
freight charges)
Communication ExpensesAuditing & Other
5. Legal, Accounting,
12. Provision for Bad Debts
Professional & Business Services Fees
6. Commission Expense
7. Cost of Activities such as Construction
Contracted and Sub-Contracted by Others & 1.2)
TOTAL OPERATING EXPENSES (1.1
13. Others Not Included Above (Specify)
SUB-TOTAL (1.2 - 1 to 13)
P
P
2. DEPRECIATION
P
3. INTEREST EXPENSES
P
4. DEPLETION CHARGES
P
5. ENVIRONMENTAL COST
P
6. SOCIAL DEVELOPMENT COST
P
PART 10 - TAXES PAID (December 31, _________), Value in Thousand Pesos
1. NATIONAL IMPOSITIONS
1.1 Excise Tax on Minerals
P
1.2 Income Tax
1.6 Documentary Stamp Tax
P
1.7 Other National Taxes (Specify)
1.3 Customs Duties/Fees
A.
1.4 Value added Tax
B.
1.8 Total National Taxes (1.1 to 1.7)
1.5 Capital Gains Tax
P
2. LOCAL IMPOSITIONS
2.1 Real Property Tax
P
2.7 Wharfage Fees
2.2 Local Business Tax
2.3 Residence Tax
2.9 Permit Fees
2.4 Occupation Tax
P
2.8 Sand & Gravel Tax
2.10 Other Local Taxes (Specify)
2.5 Community Tax
2.11 Total Local Taxes (2.1 to 2.10)
2.6 Registration Fees
P
3. WITHHELD TAXES
3.1 W/T on Payroll
3.2 W/T on Royalties on Claim-owners/Surface
Owners on /dividends
3.3 W/T
P
3.6 W/T on Interest Payments
P
3.7 W/T on Royalty for Transfer of Technology
3.8 Other Withheld Taxes (Specify)
3.4 W/T on Profit Remittance to Mother Company
3.5 W/T on Interest Income
GRAND TOTAL (1.8 + 2.11 + 3.9)
3.9 Total Withheld Taxes (3.1 to 3.8)
P
P
Page 3 of 4
MGB Form 29-17 (Series of 2000)
PART 11 - GROSS RECEIPTS
Report the value of sales and other receipts of this site. For goods shipped, inlcude sales and consignments, sales should be reported net of discounts,
allowances and returned goods, FOB mine site.
DESCRIPTION OF RECEIPTS
AMOUNT
1. VALUE OF SHIPMENTS OF PRODUCTS PRODUCED, MINED
P
2. OTHER RECEIPTS (Specify)
P
T O T A L (1 and 2)
P
PART 12 - INCOME STATEMENT
1. OPERATION INCOME
(GROSS RECEIPTS Less production Cost plus Operating Expenses plus Depletion Charges plus
Depreciation Charges plus Taxes Paid)
P
2. INCOME BEFORE TAX (Operating Income less Interest Expense)
P
PART 13 - REPORT ON PROBLEMS ENCOUNTERED
Describe the problems encountered in the mine site with respect to the specified areas listed below
1. RAW MATERIALS, POWER, FUEL
2. POLLUTION CONTROL
3. MACHINERIES AND EQUIPMENT
4. FINANCE AND CREDIT
5. GOVERNMENT POLICIES/REGULATIONS
6. OTHERS
PREPARED BY:
OFFICIAL DESIGNATION
ADDRESS
TELEPHONE NO.
(Signature Over Printed Name)
CERTIFIED BY:
OFFICIAL DESIGNATION
ADDRESS
TELEPHONE NO.
(Signature Over Printed Name)
CERTIFICATION
I hereby certify that all information in this report are complete,true and correct to the best of my knowledge and belief
SIGNATURE OF REPORTING OFFICIAL
OFFICIAL POSITION
DATE
REPUBLIC OF THE PHILIPPINES)
) S.S.
)
Subscribed and sworn to before me this _______day of ____, 20____, the affiant exhibiting his/her Residence Certificate
No. _______________, issued at ________________, on the _______ day of ______________ 20_____.
DOC NO.
PAGE NO
BOOK NO.
SERIES OF
NOTARY PUBLIC
My Commission Expires on Dec. 31, _________
PTR No. _____________________________
Page 4 of 4
