Republic of the Philippines

Department of Transportation and Communication

LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
Regional Office No. 4, Lipa, City

__________________________________
Case No. : ____________________
Petition for dropping/cancellation of
Unit/Franchise from ________ service
x---------------------------------------------------------------x
PETITION
PETITIONER, and to this Honorable Board respectfully alleges:
That Petitioner/s is of legal age, single/married, Filipino citizen, an a resident of
________________________________________________________________.
That petitioner is a grantee of a Provisional Authourity/Certificate of Public Convenience
to operate a : _____________________________________________________ with the use of
________________ (1) unit/s more particularly described as follows:

MAKE MOTOR NO. CHASSIS NO. PLATE NO.

_________________ __________________ __________________ _________________

That Petitioner would like to drop/cancel the said unit/s franchise from _____________
__________ service because _____________________________________________________.

That Petitioner attached herewith ___________________________________________

WHEREFORE, it is most respectfully prayed that after due consideration, the foregoing
petition be granted.
Lipa City, _____________________________.
________________________________
PETITIONER
VERIFICATION
I, ____________________________, first being duly sworn to law hereby depose and
state: That I am the applicant in the foregoing petition; That I have read and understood the
same; and that the allegations contained herein are true of my own personal knowledge.

_______________________________
AFFIANT
SUBSCRIBED AND SWORN to before me this _____ day of _______________________.
Affiant exhibited to me his/her Valid ID No. __________________________ issued at ________
_________ on ____________________________.

ATTY. TORADIO R. ESPLANA

Notary Public
Pagsanjan, Laguna
Until December 31, 2017
PTR No. 3657506 04 June 2016
Doc. No. ____; IBP Lifetime No. 1001262
Page No. ____; Roll of Attorneys 52577
Book No. ______; MCLE Compliance No. V-0021982
Series of 2016
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