Annex E

APPLICATION FOR PRELIMINARY CERTIFICATION FOR GREEN BUILDING AMENDMENT

APPLICATION NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER/ APPLICANT NAME For Building Official use

LAST GIVEN MIDDLE

IN CASE OF COMPANY NAME:

TAX IDENTIFICATION NUMBER

of Applicant

DATE OF APPLICATION

MONTH DAY YEAR

LOCATION OF CONSTRUCTION

LOT BLOCK STREET BARANGAY

QUEZON CITY
DISTRICT ZIP CODE CITY

USE OF BUILDING PROJECT (Check one)

CLASSIFICATION BUILDING ORIGINAL GROSS FLR AREA

Commercial Hotel
Commercial Office Building REVISED GROSS FLR. AREA
Commercial Mall/ market
Institutional School
Institutional Gov't Building DIFFERENCE IN TAX CREDIT
Institutional Hospital
Industrial Factory
Industrial Warehouse
BOX 2
STATEMENT

I/ WE, _____________________, with business address at ________________________

do hereby apply for Preliminary Certificate for Green Building Amendment pursuant to the provisions of
the Implementing Rules and Regulations Part I for Green Infrastructures, to wit:

1 That the building project has been granted Preliminary Certificate for Green Building with
Certificate Number. __________ dated (mm/dd/yyyy) __________ and which is located in
Quezon City;
2 That the changes of the building project which is at the time of the application are
subject to verification upon submission of revised documents (check each applicable):
Building Plans
Specifications
Calculations
Detailed Drawings
3 That the changes fall under (state whether mandatory, elective or combined)
___________________________________ requirement, specifically for:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
4 That documentary evidences covering all requirements that are applicable in Item 3
are submitted in compliance with the definition of Green Building and the
requirements of the IRR for the purpose of the application due to changes;
5 That the changes in this application are (state whether new, addition or deletion)
_________________ and have not been duplicated in previous amendments of the
Preliminary Certificate for Green Building, and
6 That as applicant, (state I or we) _____ shall comply with the terms and conditions
of the Preliminary Certification for Green Building and its Amendments
including, but not limited to, requirements of the Building Permit.
7 In case of applying for exemptions, I/ we shall comply with the requirements of Section 10 of
the IRR.

SIGNED BY APPLICANT: NOTARY: