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Application for Certificate of Registration as Lumber Dealer

DENR application form for certificate of registration as lumber dealer

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
DEPARTMENT OF ENVIRONMENT AND NATURAL
RESOURCES
NATIONAL CAPITAL REGION
North Production Nursery, North Avenue, Dil., Q.C.

Appl. Fee: _______________
Reg. Fee: ______________
Permit Fee: ______________
Oath Fee: ______________
Bond Deposit: ___________ (Cash Bond)
NEW OR RENEWAL (State) ___________________________________________________
Name of permittee : _________________________________________________________
PLACE AND DATE: ________________________________________________________
(Make your writing legible. Fill all spaces properly to avoid delay).
APPLICATION FOR CERTIFICATE OF REGISTRATION AS LUMBER DEALER
THE REGIONAL EXECUTIVE DIRECTOR
THRU: THE Regional Technical Director, FMS
The Chief, FULED
DENR-NCR, Quezon City
Sir:
1.

I, ___________________________ of ___________________________ with business
address located at _______________________________ , a citizen of the Philippines
hereby apply for a Certificate of Registration as Lumber Dealer.

2.

I am _________ a government employee and __________ receive compensation of
__________________from the government. (If a government employee, a written
permission from the Department Head must be submitted).

3.

My place or propose business address is in __________________________________
______________________________________________________________________

1.

The expected gross annual volume of my business operation is _____________ valued
at ______________________.

2.

The total number of men employed or to be employed is/are ________ with
corresponding total of _____ dependents.

3.

Kind of equipment used or to be used, state type, make size, and value:
________________________________________________________________________
________________________________________________________________________

4.

I am selling or intend to sell my product on a _______________ ( wholesale or retail) to
in and nearby provinces, if the dealer is an alien, a photocopy or Xerox copy of his/her
permit to engage in retail business must be submitted.

5.

My experienced as Importer/ dealer is ______________________

6.

My previous Certificate of Registration as Lumber Dealer No. __________ issued on

7.

________.
The original contract duly notarize with the suppliers stating the volume of
______________ to be supplied as enumerated hereunder.

NAME OF SUPPLIER

PERMIT NO.

DATE ISSUED

EXPIRY
DATE

VOLUME
APPLIED

8. Should this application be accepted, I obligate myself to comply faithfully with the terms
and conditions of my permit and with all rules and regulations and instruction issued in
connection with Republic Act No. 1235,460 and P.D. 705.
9. I understand that the mere filing of this application together with the submission of the
complete requirements (as attached) and on my voluntary remittances of the fees in
advance, do not authorize me to operate the processing plant without the
regular/provisional permit applied for actual issued to me.
10. In applying for this permit, I do so for the firm knowledge it may or may not be favorably
considered and have all the attendant risk and cost voluntarily.
11. I finally understand that the making of false statement on the application shall be
considered sufficient for disapproval and that any false statement or material omission of
the facts intentionally done, altering, changing or modifying the consideration of any of
the conditions mentioned in said application may cause the cancellation of the
license/permit, if already issued, without prejudice on the part of the government to
cause the prosecution of the guilty party.
__________________________
Signature of Applicant
AFFIDAVIT
Republic of the Philippines)
_____________________) S.S
I, _____________________, the applicant, having been solemnly sworn upon my oath,
depose and say, that I have thoroughly read the foregoing application, and each and every
statement in said application is true and correct to the best of my knowledge and belief.
___________________________
Signature of Applicant
BEFORE ME, at the City indicated in this __________ day of _______________ 201_,
personally appeared the same person whose name and signature with his/her Community Tax
Certificate No. _____________ ISSUED ON ____________ ISSUED AT ______________ with
Tax Identification (TIN) No. ___________________.

________________
Team Leader
Officer Authorized to Administer Oath
Affix Doc. Stamp
C/Forms/elz/02
 
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