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Application For SAG

This document contains an application for a commercial sand and gravel permit in the province of Surigao del Norte, Philippines. The applicant provides their name, address, size of the applied area, and location details. They agree to pay fees for the materials and provide a bond. The applicant also certifies the statements in the application are true to the best of their knowledge. Instructions note the application requires five copies, all information must be provided, and incomplete applications will not be accepted.

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Alverastine An
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111 views

Application For SAG

This document contains an application for a commercial sand and gravel permit in the province of Surigao del Norte, Philippines. The applicant provides their name, address, size of the applied area, and location details. They agree to pay fees for the materials and provide a bond. The applicant also certifies the statements in the application are true to the best of their knowledge. Instructions note the application requires five copies, all information must be provided, and incomplete applications will not be accepted.

Uploaded by

Alverastine An
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines PROVINCE OF SURIGAO DEL NORTE PROVINCIAL ENVIRONMENT MANAGEMENT OFFICE Provincial Capitol, Surigao City

APPLICATION FOR SAND AND GRAVEL COMMERCIAL PERMIT


New Renewal

Application No. ____________________________ Date Filed: __________________ Applicant : ____________________________________________________________ Address : ____________________________________________________________ Size of Applied Area (hectare) : _____________________________________

THE PROVINCIAL GOVERNOR Province of Surigao del Norte Capitol, Surigao City Madam: In accordance with the provisions of the Philippine Mining Act of 1995 and its revised Implementing Rules and Regulations, the undersigned ____________________ for and in behalf of _________________________________, hereby applies for a Commercial Sand and Gravel Permit to remove and dispose ________ cubic meters of materials authorized thereunder from the tract of land bounded as follows: (PLEASE SEE ATTACHED SKETCH/LOCATION MAP) On the North On the East On the South On the West ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

With an approximate are of __________ hectares. The area applied for is public and/or private land, lake, river, stream, creek or other public waters (underline applicable term), located in Sitio of _________________, Barangay of _____________________, Municipality/City of _____________________, Province of Surigao del Norte, Island of Mindanao, Philippines.

1. 2.

The application fee of ______________________ has been paid under official Receipt No. _______________________ dated ____________, 2012 Philippines; The applicant binds himself or itself to pay the amount of _______________________ (P ____________________) covering the total fee for

the materials applied for, and to file a ____________________ Bond (surety, cash or personal) in the amount of ___________________ (P ____________________) ; 3. This application is filed for the exclusive use and benefit of the applicant, and not either indirectly for the benefit of any other persons, corporation or partnership, and for the sole purpose of removing and disposing of the said materials. This applicant agrees that the statements made in the application or made later in support thereof shall be considered as conditions and essentials parts of the permit that may be granted by virtue thereof, and any falsehood in these statements on 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.

4.

The foregoing statements are hereby certified to be true to the best of the applications, 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 said application is true and correct. __________________________ Applicant TIN _______________________

ACKNOWLEDGEMENT Republic of the Philippines_________) Province of _____________________)S.S. City/Municipality of ______________) X- - - - - - - - - - - - - - - - - - - - - - - - - - - -/ SUBSCRIBED AND SWORN to me before me at the place aforesaid, on this __________________ day of ________________________, 20 _______________. The affiant exhibited to me his/her Community Tax Certificate No. _________________________ issued at ____________________ on the __________ day of ____________, 20 ___________.

________________________ NOTARY PUBLIC Until Dec. 31, 20 __________ 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 Mining Regulatory Board, and the remaining copy for the files of 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 required documents shall not be accepted.

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