MGB Form 29-12 (Series of 2000)

Republic of the Philippines

Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Mineral Economics, Information & Publications Division
North Avenue, Diliman, Quezon City

MONTHLY REPORT ON PRODUCTION, SALES AND INVENTORY OF INDUSTRIAL SAND & GRAVEL AND EMPLOYMENT
REPORT PERIOD: MONTH: APRIL YEAR: 2023

INSTRUCTIONS:
1. This form must be accomplished in duplicate
2. Submit the original copy to the MGB Central Office through the Mineral Economics, Information & Publications Division, copy furnished the Concerned Region
within fifteen (15) working days after the end of each calendar month.
3. Submission of this report is in compliance with SECTION 270, CHAPTER XXIX, OF DENR AO 96-40 or the implementing rules and regulations of
REPUBLIC ACT 7942
4. Information to be supplied by the reporting Operator/Permit Holder should cover the period from the first day to the last day of the report month.
5. This report form must be accomplished by a Holder of a Industrial Sand & Gravel Permit or its Operator
6. Write within the space provided for your answers and do not leave any of the requirements unanswered.
7. If a requirement does not apply to you, write NA (Not Applicable). If the question is applicable to you but you have no answer, write NONE.
8. This document should be signed by the resident manager or equivalent position.
9. This report should be duly notarized.
10.For any comments, suggestions or clarifications regarding this form please consult your nearest MGB Regional Office in your area.
DEFINITION OF TERMS
Mining Company is composed of one Head Office and one or more Mine Sites.
Head Office undertakes the job overall company administration. The mining company may or may not have a separate headquarters,
rooms or ports which house the personnel charged with the task
Mine Site refers to the location of mine where mining operations, specifically mineral extraction, takes place (Barangay, Municipality, Province)
Production quantity refers to the total volume of mineral extracted during the reporting period expressed in cubic meter
Production value refers to the total value of gross output of mineral extracted during the reporting period as defined in Chapter 1, Section 5 of the Revised IRR of the Phil. Mining Act of 1995.
(under the term "Gross Output")
Estimated extraction fee payable refers to an estimate of the total extraction fee to be paid by the permittee covering the production during the reporting period and based on the prevailing
extraction fee rate in the province/city.
Sales quantity refers to the total volume of mineral sold during the reporting period expressed in cubic meter
Sales value refers to the total value of mineral sold during the reporting period. This value includes all costs of production, taxes invoiced to purchasers, transport
& trade mark-up
Estimated Excise Tax Payable refers to an extimate of the total excise tax on minerals to be paid by the permittee to the Bureau of Internal Revenue (BIR) covering the production during the
reporting period and based on the rate prescribed by Section 217 (b) of the Revised IRR of the Mining Act of 1995.

I. ADMINISTRATIVE DATA
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 MGB Form 29-12 (Series of 2000)
Name of Permit Holder/Operator: CAPT. MARIO A. AVILA Tax Identification No.: 126-504-504-000 Contact No.: (+63) 939-9399-476
Official Address: Purok 7, Brgy. Putting Bato, Cabadbaran City, AdN 8605 FAX: N/A E-mail Address: [email protected]

Location of Quarry: Purok 7, Brgy. Putting Bato, Cabadbaran City, AdN 8605 No. of Days in Operation: 26

Date of First Operation: September 19, 2023 Permit No. 03-MGB13(ADN) Date Approved: December 24, 2021 Date Expired: December 23, 2026

II. PRODUCTION & SALES/MARKETING DATA (Use additional sheet if necessary)

Construction PRODUCTION SALES MONTHLY INVENTORY ESTIMATED ESTIMATED Buyer/
Materials Quantity Value Quantity Value Quantity Value EXTRACTION EXCISE Address
(cu.m.) (P) (cu.m.) (P) (cu.m.) (P) FEE PAYABLE TAX PAYABLE

1. Sand
Fine 0 0 0 0 0 0 0 0 N/A
Screened 2397.6 479520 0 0 3924 784800 117720 31392 N/A
2. Gravel
G1 0 0 0 0 0 0 0 0 N/A
G2 0 0 0 0 0 0 0 0 N/A
3. Others (pls. specify) 0 0 0 0 0 0 0 0 N/A

Note: If three or more buyers just indicate "various buyers"

Production volume was estimated and calculated with a recovery of 50% sand during screening.
Reasons for increase or decrease in production this month compared to the previous month: (pls. check appropriate answer below and use additional sheet if necessary
Increase was due to: Decrease was due to:
1. Increased price of 1. Lesser operating days
the mineral being 1.a Equipment breakdown (pls. specify)__________________________________________ 2.d Environmental Problems (pls. specify)_________________________
produced 1.b Unfavorable weather condition (state duration or other information)_________________ 2.e Gov't preventive actions such as CDO (pls. spec Permit-related issues
2. Increased demand 1.c Labor or other strikes (state duration) 2.f Financial Problems (pls. specify) ______________________________
3. Expansion 2. Suspension due to 3. Others (pls. Specify) _________________________________________________
4. More operating days 2.a Low price of the mineral commodity produced (pls. Specify)__________________________
5. Others (pls specify) 2.b Market Problems (pls. specify)_________________________________________________
Favored by the LGU to execute 2.c Force Majeure (pls. specify)___________________________________________________
its operation

III. EMPLOYMENT DATA

Report the number of persons engaged in work at the office and site during this month
OFFICE QUARRY SITE TOTAL
MALE FEMALE MALE FEMALE MALE FEMALE
MAA SGA 1 0 2 0 3
Contractor 3 0 13 0 16
TOTAL 19

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 MGB Form 29-12 (Series of 2000)
PREPARED BY: OFFICIAL DESIGNATION ADDRESS CONTACT NO.

ENGR. VINCENT KLEIN LOUISE C. NACU MINING ENGINEER Brgy. Golden Ribbon, Butuan City, Agusan del Norte 8600 (+63) 939-9399-476

IV. CERTIFICATION

I hereby certify that all information in this report are true and correct to the best of my knowledge and belief.

ENGR. VINCENT KLEIN LOUISE C. NACUA, EM MINING ENGINEER ________________

SIGNATURE OF REPORTING OFFICIAL OFFICIAL POSITION DATE

REPUBLIC OF THE PHILIPPINES)

BUTUAN CITY ) S.S.
AGUSAN DEL NORTE )

Subscribed and sworn to before me this ______ day of _________________, 20____ , the affiant exhibiting his/her PRC No. 0004594,
issued at Butuan City on the 23rd day of September, 2021.
DOC NO.
PAGE NO NOTARY PUBLIC
BOOK NO. My Commission Expires on Dec. 31,_____.
SERIES OF PTR No. ________

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