Republic of the Philippines

Department of Environment and Natural Resources

COMMUNITY ENVIRONMENT AND NATURAL RESOURCES OFFICE
DENR Cenro Mobo Bldg. Pinamarbuhan, Mobo, Masbate
E-mail add: denr_cenromobo@yahoo.com
Tel.No. (056)333-1733

APPLICATION FOR PERMIT

AND ACCEPTANCE OF CONDITIONS

1. The undersigned hereby makes application, pursuant to the provisions of Act No. 3077,
and Bureau of Lands Administrative Order No. 8-3 as amended for permit to temporarily
or provisionally occupy and use for , the tract of land described below:

The land is located in the Barrio of _________, Municipality/City of Masbate,

Province of Masbate and it contains approximately an area of Six (6) sq. m.
Its boundaries are:
North: ________________ West: __________________
East: _________________ South:__________________
The land is covered by ______________________ Application No.
______________.
I shall use the land for

2. To show that I possess the qualifications rendered by law, the foregoing statement of
facts
is submitted:

3. My name is __________________ my age is ___ years old. I was born in

__________________________, I am citizen of the Philippines. My Post Office address is
__________________________________________ I am married/single and the name of
my wife/husband is _________________ who is a citizen of the _____________.

4. I am _____ holder of ________ applications for public land. They are as

follows:

5. I have read the instructions and conditions specified in the application; and undertake to
abide by them as well as the provisions of the aforesaid Administrative Order No. 8, as
amended under which permit is to be issued and I promised to comply with all the laws and
regulations governing the occupation and use of public lands. THIS APPLICATION MAY
THEREFORE CONSIDERED AS MY ACCEPTANCE OF THE CONDITIONS PRESCRIBED BY EXISTING
LAWS, RULES AND REGULATIONS AS WELL AS THOSE OTHERS WHICH, TO PROTECT PUBLIC
INTEREST, MAY BE PRESCRIBED BY THE SECRETARY OF THE DENR OF THE DIRECTOR OF LANDS
AND EXPRESSLY STATED ON THE PERMIT AND MADE A PART HEREOF.

___________________
Signature of Applicant

Address:

Witness at:
1. __________________________
Address:__________________________________
2. __________________________
Address:__________________________________

Submitted and sworn to before me this ______ day of ________, 2021 at Masbate
City, Philippines. Affiant exhibiting his/her _____________________ No.
____________
Issued on ________ of _________, ________ at _____________, Philippines.

_______________________
 CONDITIONS UNDER WHICH PERMITS ARE ISSUED

1. This application is not made for the benefit of any person other than the applicant.
2. This permit is to be issued under the conditions prescribed by the Administrative
Order No. 8 as amended, and such additional conditions as may deem necessary,
according to attending circumstances or to protect public interest, which special
conditions shall be expressly stated in and made part of the permit.
3. The permtitee shall occupy and put the land subject to the permit to the use for which
the permit is to be used within the months from the date of the permit upon the
penalty of losing his right over the land through the cancellation of the permit
accompanied by the forfeiture of the fees paid for the failure to occupy and use the
land within the periods herein follows.
4. No building or structure shall be constructed or created on the land without its plan
and construction having been previously approved by corresponding authorities in
accordance with local ordinance;
5. This permit shall not be transferred or assigned without the written consent of the
Director of Lands;
6. Should the permit be cancelled by reason or the failure of the permittee to pay the
permit fees all improvements found thereon shall be forfeited to the government.
7. Upon discovery, the permittee shall immediately notify in writing the Director of
Lands of the existence in the land of any gold, silver, copper or other substance
containing minerals, guano, jums, precious stones, coal or coal oil, and he shall not
take or remove nor suffer to take or remove from the place any quantity of the said
product.
8. This permit is subject to the favourable recommendation of the District Engineer, the
Collector of Customs, and further findings are necessary but were not available and
were therefore not considered at the time of the issuance of the permit;
9. Person holding licenses issued by the Bureau of Forestry shall have rights-of-way on
the land and also the right to cut and remove timber thereon.
10. Any timber growing on the land shall not be cut and dispose of for commercial
purposes without license from the Bureau of Forestry.
11. No improvements on the land covered by the permit shall be sold, mortgaged or in
any manner encumbered without the written permission of the Director of Lands.

(SKETCH OF LAND)