DPWH ROW Procedural Manual

Appendix 33
PERMIT TO ENTER

Date: ________________

I, , of legal age and single/married, with residence

address at , as the registered owner of a parcel
of land situated in Barangay ________________ , City/Municipality of ,
Province of , the title thereto being evidenced by Original Certificate
of Title/Transfer Certificate of Title/EP/CLOA/Tax Declaration No. , issued by
the Assessor’s Office of _______________________ , hereby irrevocably, unconditionally and
absolutely authorize, permit, and allow the Republic of the Philippines, acting by and through the
Department of Public Works and Highways (DPWH), its successors’ and assigns, contractors
and subcontractors, and agents and representatives, unimpeded entry and unlimited access to the
said parcel of land and to conduct and undertake surveying, clearing and removal of structures,
improvements, crops, trees, and other items therein, soil tests and other engineering
investigations, design, pre-construction and actual construction activities as well as other
activities needed for or related to the design and implementation of the DPWH Project entitled
______________________ .

Name and Signature of Landowner

Attested by:

DPWH ROW Engineer

146