MGB Form 29-16 (Series of 2014)

MGB Form 29-16 (Series of 2014)

Republic of the Philippines
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Mineral Economics Information and Publication Division
North Avenue, Diliman, Quezon City

INTEGRATED ANNUAL REPORT OF METALLIC MINERALS, NON-METALLIC MINERALS AND QUARRY RESOURCES
For the Report Year : 2022

NAME OF COMPANY/LICENSE/PERMITTEE: NOEL W. RECAMARA

ADDRESS (Mailing address): PUROK SAN ROQUE, SICAYAB, DIPOLOG CITY

PART I - MINING COMPANY INFORMATION

Permit or Contract Number: IP-024-13-IX Date Established: October 3, 2013 Tax Account Number: 905-860-866
COMPANY NAME - (Write below the correct name of company if it is not the same as in the address box. If name of person, write surname first.)
ISAG - NOEL W. RECAMARA / Riversand Enterprises and Services
ADDRESS (Write the correct address if it is not the same as in the address box)

Telephone Number: (Write only one telephone number and one local number)
Cell No. 09273927396 Local No.: None Fax No.: None E-mail Address: brigidodiaolim@gmail.com
FORM OF OWNERSHIP: (Indicate if Single Proprietorship, Partnership, Corporation, Cooperative, Association or Government)
Single Proprietorship
PERCENTAGE OF OWNERSHIP: (Indicate in percent if Filipino, Canadian, American, Chinese, Japanese, British,Spanish based on capital invested as of the end of reported year.)
100% Filipino
NAME OF MANAGING OFFICIAL: POSITION:
NOEL W. RECAMARA Manager/Proprietor

PART 2 - OPERATING EXPENSES AND OTHER CHARGES

(Please write all expenses incurred by the HEAD OFFICE solely on mining operations/activities. Value in Thousand Pesos ('000))

1. OPERATING EXPENSES
1.1 Salaries and Wages P 494.44 1.10 Commission Expense -
1.2 Supplies Expense 18.57 1.12 Donations and Contributions (SDMP) 90.17
1.3 Repair and Maintenance of Buildings & Equipment 829.51 1.13 Cost of Assets Sold in the Same Conditions as -
(fees received by others) Purchased

1.4 Utilities Expense 599.68 1.14 Royalties outside of those paid Under Taxes -
1.5 Insurance Payments (excluding those related to - 1.15 Rentals Expense Outside of Those Paid Under -
employment) Taxes

1.6 Marketing Expense 1.16 Provisions for Bad Debts -

1.7 Telephone, Telegraph, Postage & Other 36.80 1.11 Cost of Activities, such as Construction & -
Communication Expenses Exploration, Contracted or Sub-Contracted to other
Companies/Entities

1.8 Transport Expense - 1.17 Others not included above (specify)

1.9 Legal, Accounting,, Auditing & Other Professional &
Business Services Fees TOTAL (1.1 to 1.17) P 9,975.00
84.00
2. DEPRECIATION CHARGES P 402
3. INTEREST EXPENSE P 192.642

PART 3 - TAXES PAID IN FY 2021, Value in Thousand Pesos ('000)

1. NATIONAL IMPOSITIONS
1.1 Excise Tax on Minerals P 172.99 1.7 Other National Taxes (Specify)
1.2 Income Tax 120.43 A. Fringe Benefit Taxes -
1.3 Customs Duties/Fees - B. BIR Form 0605 -
1.4 Value added Tax 351.54 C. Bus. Registration 0.50
1.5 Capital Gains Tax - D. Other National Taxes and Fees -
1.0 Total National Taxes (1.1 to 1.7)
1.6 Documentary Stamp Tax - 645.46
P

2. LOCAL IMPOSITIONS
2.1 Real Property Tax P 5.90 2.7 Wharfage Fees P -
2.2 Local Business Tax 12.06 2.8 Sand & Gravel Tax -
2.3 Occupation Fees - 2.9 Extraction Fees 445.85

2.4 Community Tax 0.53 2.10 Other Local Taxes (Specify) -

2.5 Registration Fees - 2.10.1 Mineral Transport Permit Fee -

2.0 Total Local Taxes (2.1 to 2.10)
2.6 Permit Fees - 720.00
P

3. WITHHELD TAXES
3.1 W/T on Payroll P - 3.7 W/T on Royalty for Transfer of Technology -
3.2 W/T on Royalties on Claim / Surface Owners - 3.8 Other Withheld Taxes (Specify) -
3.3 W/T on /Dividends - 3.8.1 -
3.4 W/T on Profit Remittance to Mother Company - 3.8.2 -
3.5 W/T on Interest Income - 3.8.3 -
3.6 W/T on Interest Payments - 3.0 Total Withheld Taxes (3.1 to 3.8) -

GRAND TOTAL (1.0 + 2.0 + 3.0) 1,365.46

4. ROYALTY PAYMENTS -
4.1 Government / Mineral Reservation - None
4.2 Claimowners and/or Surface Owners - None
4.3 Indigenous Peoples - None

Page 1 of 24
 MGB Form 29-16 (Series of 2014)

PART 4 - FIXED ASSETS AND CAPITAL EXPENDITURES

Report the value in thousand pesos ('000) of all fixed assets of the HEAD OFFICE. Include improvements on land such as culverts, sidewalks, wall, roads, waiting
sheds and other structures. Include also value of tools which last for more than a year, value of all equipment used for transporting persons, freight and other materials,
office equipment, drinking fountain, filing cabinets and others.

Reserve for Capital Expenditures

1. Land
2. Buildings & Structures
3. Transport Equipment
4. Processing Facility
5. Other Heavy Equipment
6. Other Fixed Assets
TOTAL (1 to 6)
Book Value at Beg. of Report Receipt from Book Value at End of Report
Depreciation Used/2nd
Year Jan. 1, 2022 Dec. 31, 2022 New/Ist Hand Sales Year Dec. 31, 2022
Hand
1,000.00 - - - - 1,000.00
700.00 - - - 700.00
2,945.80 172.80 - - - 2,773.00
- - - - - -
1,242.00 229.12 - 1,012.00
127.27 - - - - 127.27
P 6,015.07 401.92 - - - 5,612.27

PART 5 - SUMMARY OF OUTSTANDING LOANS (Value in Thousand ('000))

This refers to the amount of loans as of end of report year. Indicate in appropriate spaces provided the amount of loan according to source.
Amount of New Borrowings During Jan-Dec of Report Year 2021
Oustanding Loans Deferred Credits
SOURCES OF LOANS at End of Report
Year Dec. 31, 2021 Cash Loans Guarantee/
Machinery & Equipment Raw Materials
Security
1. Foreign (specify country) $0 $0 $0 $0 $0

2. Local (specify source of loans)

Rural Bank of Rizal 1,533.00 - 1,533.00 - -
Trade and Other Payables 2,379.00 - -
-
-
- - -
3. Loan Repayments (Principal) LOCAL : P 1,672 FOREIGN: $ 0

PART 6 - SUMMARY OF INCENTIVES AVAILED OF (Value in Thousand Pesos ('000))

SOURCE / VALUE OF INCENTIVES AVAILED OF

NATURE OF INCENTIVES
Board of Investments Mines and Geosciences Bureau Other Agencies
1. Allowable Deduction - - -
1.1 Accelerated Deduction of Organizational & Pre-Operating None None None
Expenses
1.2 Accelerated Depreciation None None None
1.3 Net Operating Loss Carry-Over None None None
1.4 Deduction for Expansion Reinvestment None None None
1.5 Double Deduction of Promotional Expenses None None None
1.6 Double Deduction of Shipping Costs None None None
1.7 Allowance for Investment In a Pioneer Enterprise None None None
2. Tax-Exemptions - - -
2.1 Compensating Tax On Imported Capital Equipment None None None
2.2 Import Duty On Imported Capital Equipment None None None
2.3 Sales Tax (Pioneer Enterprise) None None None
2.4 Advance Sales Tax On Imported Raw Materials, Supplies, etc. None None None
(Pioneer Enterprise)
2.5 Capital Gains Tax-Exemption None None None
2.6 Tax-Exemption On Sale of Stock Dividends None None None
3. Tax Credit - - None
3.1 Tax Credit for Witholding Tax On Interest Payments on Foreign None None None
Loans
3.2 Tax Credit On domestic Capital Equipment None None None
3.3 Special Tax Credit On Raw Materials/Supplies of Exported
Finished Products None None None
TOTAL (1 to 3) P - - None

PREPARED BY: OFFICIAL DESIGNATION ADDRESS TELEPHONE NO.

BRIGIDO D. LIM
PCO Purok San Roque, Sicayab, Dipolog City 9985696477
(Signature Over Printed Name)

CERTIFIED BY: OFFICIAL DESIGNATION ADDRESS TELEPHONE NO.

NOEL W. RECAMARA Manager Purok San Roque, Sicayab, Dipolog City 9273927396
(Signature Over Printed Name)

Page 2 of 24
 MGB Form 29-16 (Series of 2014)

MINE SITE PARTICULARS

ANSWERS SHOULD REFLECT INFORMATION PERTAINING TO MINE SITE ONLY

PART 7 - MINE INFORMATION

SITE NAME: REGION: PROVINCE: MUNICIPALITY:

Sand & Gravel Concession of Noel Recamara IX Zamboanga del Norte Dapitan City

Major Product (Enter only one major product per site) Date of First Operation Change

Gravel/Boulders Year: 2013 Month: October Day: 3 0

MINING METHODS USED: (Enter only one mining method per block) MILLING METHODS USED: (Enter only one milling method per block)
1. Equipment-based 1. Rock Crushing
2. Manual or labor-based 2.
3. 3.
CAPACITY IN METRIC TON: (Mining) 20,000/Annum CAPACITY IN METRIC TON: (Milling) 20,000/Annum
SMELTER/REFINERY (LOCAL AND FOREIGN): N/A ESTIMATED RESERVE: N/A
SHIPPING POINT (PHIL. PORT) NAME OF SMELTER/REFINERY/BROKER/DESTINATION ADDRESS OF SMELTER/REFINERY/BROKER DESTINATION
N/A None N/A N/A N/A
N/A None N/A N/A N/A
N/A None N/A N/A N/A
COMPANY CONTRACTED TO OPERATE THIS SITE (if any): None
NAME OF CONTACT PERSON: N/A ADDRESS: N/A

PART 8 - TOTAL PRODUCTION

UNIT GROSS QUANTITY GROSS VALUE (000) AVERAGE GRADE
A. PRIMARY

B. BY-PRODUCTS
Mixed, G2, G-1, Sand cu.m. 8,692.00 3,652.27 N/A

PART 9 - TOTAL EXPORT/ LOCAL SALE

COUNTRY OF GROSS QTY GROSS VALUE

DESTINATION
AVERAGE GRADE
(Specify Unit Used) Pesos (P'000) Dollars ($'000)
A. PRIMARY
-

B. BY-PRODUCTS
Mixed, G-2, G-1, Sand Local 8,917 cu.m. 5,883.32 - N/A

PART 10 - PRODUCTION COST: COST OF USED MATERIALS AND SUPPLIES

Report the value of materials and supplies used during the report year. Include industrial and non-industrial costs incurred by this site in its operations. Allocate
accounts to headiing. Value in thousand pesos ('000).

HAULING,
UNIT OF HANDLING & ADMINIS-
ITEMS
MEASURE
VOLUME MINING MILLING (60%)
STORAGE TRATION
TOTAL
(40%)

1. Grease and Lubricants liters 452.00 - 271.20 180.80 - 92.41

2. Chemicals N/A 0 0 0 0 0 -
3. Explosives N/A 0 0 0 0 0 -
4. Spare Parts/Repairs - - 497.50 332 - 829.50
5. Containers and Packing Materials - - - - -
6. Lumber 0 0 0 0 0 -
7. Steel Balls 0 0 0 0 0 -
8. Non-Durable Tools - - - - - -
9. Others Not Included Above - - -
TOTAL COST OF USED MATERIALS AND SUPPLIES BY SOURCE P - 768.70 512.72 - 921.91
CONVERSION RATE: (US $1.00 = P)

PART 11 - PRODUCTION COSTS: COST OF FUELS AND UTILITIES

Report the value of fuel and utilities consumed during the report year. Allocate accounts according to heading. Value in thousand pesos ('000).
1. COST OF FUELS (indicate if gas, gasoline, diesel oil, bunker oil, coal, etc)
HAULING,
UNIT OF HANDLING & ADMINIS-
QUANTITY MINING (30%) MILLING (30%) TOTAL AMT
MEASURE (liter) STORAGE TRATION
(40%)

Gas Liter - - - - - -
Gasoline Liter - - - - - - -
Diesel oil Liter 2,305 62.25 62.25 83.00 - 207.51
Bunker oil Liter - - - - - - -
Coal Liter - - - - - - -

TOTAL COST OF USED FUELS BY SOURCE P 62.25 62.25 83.00 - 207.51

CONVERSION RATE: (US $1.00 = P)

Page 3 of 24
 MGB Form 29-16 (Series of 2014)
2. COST OF UTILITIES ('000)
HAULING,
UNIT OF ADMINIS-
QUANTITY MINING MILLING HANDLING & TOTAL
MEASURE STORAGE TRATION

2.1 Water Liter -

a. Purchased Liter 0 - - - - -
b. Generated (No Cost) Liter 56,000 - - - - -

2.2 Electricity KWH - -

a. Purchased kwh 19,672 - 562.87 - 562.87
b. Generated N/A - - - -
b.1 By the above fuels N/A - - - - -
b.2 By Other Sources N/A -
3. Sold N/A 0 - - - -
TOTAL (2.1 + 2.2 + 3) P 0 - 562.87 - - 562.87

PART 12 - PRODUCTION COST: COST OF LABOR

Report number of persons who worked in or for this company, their basic salaries and wages, overtime pay and benefits for work done by regularly paid employees
within the report year, paid in cash and in kind prior to all deductions such as witholding tax, group insurance, union fees, etc. Value in thousand pesos ('000).

Number of EXTRA EXTRA

TYPE OF REGULARLY-PAID SALARIES & OVERTIME
Regularly Paid SSS BENEFITS BENEFITS PAID TOTAL
EMPLOYEES Employees WAGES PAY PAID IN CASH IN KIND

1. MINING - - -
a. Skilled 1 46.75 - 4.88 4.87 - 56.50
b. Laborer - - -

2. MILLING
a. Skilled 1 87.98 7.89 7.52 103.38
b. Laborer 1 106.29 9.54 9.06 124.89

3. Hauling, Handling & Storage

a. Skilled 1 76.83 - 6.57 6.52 89.91
b. Laborer 1 99.05 - 8.82 8.50 - 116.37
-
4. Administrative Workers 1 103.25 11.54 8.63 123.42
TOTAL (1 to 4) 6 520.00 - 49.00 45.00 - 614.47

PART 13 - OPERATING EXPENSES AND OTHER CHARGES

Report the value of expenses of the MINESITE for the report year. Include industrial and non-industrial charges incurred in the operations. Value in thousand pesos ('000).

1. OPERATING EXPENSES
1.1 Marketing Expense
1.1.1. Smelter Charges - 1.1.4. Assaying & Analysis Charges -
1.1.2. Refinery Charges - 1.1.5. Other Marketing Expenses -
1.1.3. Freight Charges (Excluding customs duties) - SUB-TOTAL (1.1.1 to1.1.5) P -

1.2 General & Administrative Expenses

1.2. 1. Repair & Maintenance of Buildings and 1.2.8. Cost of Assets Sold In The Same
equipment (Fees received by Others) - Condition as Purchased -
1.2.2. Insurance Payments (excluding those
related to employment) 1.2.9. Donations and Contributions (SDMP)
16.00 90.17
1.2.3. Transportation Expense (outside of 1.2.10. Rentals Expense Outside of Those
production and freight charges) - Paid Under Taxes -
1.2.4. Telephone, Telegraph, Postage and Other
Communication Expenses 1.2.11. Royalties Outside of Those Paid Unde
24.00 -
1.2.5. Legal, Accounting, Auditing & Other
Professional & Business Services Fees 1.2.12. Provision for Bad Debts
84.00 -
1.2.6. Commission Expense - 1.2.13. Others Not Included Above (Specify)
1.2.7. Cost of Activities such as Construction
Contracted and Sub-Contracted by Others SUB-TOTAL (1.2.1 to 1.2.13) P 214.17
-
TOTAL OPERATING EXPENSES (1.1 & 1.2) P 214.17

2. DEPRECIATION P 402
3. INTEREST EXPENSES P 193
4. DEPLETION CHARGES P 0
5. ENVIRONMENTAL COST -AEPEP P 279
6. SOCIAL DEVELOPMENT COST P 90

Page 4 of 24
 MGB Form 29-16 (Series of 2014)
PART 14 - FIXED ASSETS AND CAPITAL EXPENDITURES
Report the value of fixed assets of the MINESITE. Include improvements on land such as culverts, sidewalks, walls, roads, waiting sheds, and other structures. Include
value of tools which last for more than one year, value of all equipment used for transporting persons, freight and other materials, office equipment, drinking fountains, filing
cabinets and others. Value in thousand pesos ('000).

Capital Expenditures
Book Value at Beg. of Report Reserve for Receipt from Book Value at End of Report
Year Jan. 1, 2022 Depreciation Used/2nd Sales Year Dec. 31, 2022
New/Ist Hand
Hand
1. Land 1,000.00 - - - - 1,000.00
2. Mining Property and Claims - - - - - -
3. Buildings & Structures 600.00 - - - 600.00
4. Machineries & Other Production
Equipment 10,000.00 2,000.00 - 8,000.00
5. Transport Equipment 2,945.80 172.80 - 2,773.00
6. Pollution Control Devices - - -
7. Other Fixed Assets -
TOTAL (1 to 7) P 14,545.80 2,172.80 - - - 12,373.00

PART 15 - SUMMARY OF CONTRACTED AND SUB-CONTRACTED ENTITIES

Report the names of the companies/entities contracted to perform certain
NAME OF COMPANY/ENTITY NATURE OF JOB
1. NONE N/A
2. NONE N/A
3. NONE N/A

PART 16 - REPORT ON PROBLEMS ENCOUNTERED

Describe the problems encountered in the mine site with respect to the specified areas listed below
1. RAW MATERIALS, POWER, FUEL
high cost of fuel and power
2. POLLUTION CONTROL
none, so far
3. MACHINERIES AND EQUIPMENT
machine breakdown, availability of spare parts, high cost of repair & maintenance
4. FINANCE AND CREDIT
financing rates are high in private finance institutions
5. GOVERNMENT POLICIES/REGULATIONS
Rigid
6. OTHERS

PART 17 - EXPLORATION PROJECTS

Indicate the type of projects whether for diamond drilling, aditing/tunnelling, geology or assaying & analysis charges. Name the location, type of reserves, meterage
advance and cost in thousand pesos for each type of project.
Ore Reserves Meterage
Location Cost ('000)
Positive Probable Possible Advance
A. Minesite Exploration Project(s) N/A -
-
-
B. Outside Exploration Project(s) N/A
-
` -

PART 18 - EXPANSION PLANS / NEW PROJECTS WITHIN OR OUTSIDE THE MINE SITE/No plan for expansion
SITE NAME: REGION: PROVINCE: MUNICIPALITY:

N/A N/A
Major Product (Enter only one major product per site) Target Date of Operation
Year: Month: Day: -
CAPACITY IN METRIC TONS: 1) MINING 2) MILLING:
PROJECT COSTS: (Name the specific COSTS INCURRED by this Project)

PERCENTAGE OF OWNERSHIP: (Name the specific NATIONALITIES that will participate in this project; include their PERCENTAGE OF OWNERSHIP)
N/A
GOVERNMENT LOANS / INCENTIVES:
GOVERNMENT INSTITUTION / AGENCY NATURE OF LOANS / INCENTIVES
N/A N/A

EMPLOYMENT GENERATION
TYPE OF EMPLOYEES NUMBER
N/A N/A

PROJECT DESCRIPTION: N/A

1. TYPE OF PROJECT: Extraction and processing of SAG Aggregates
2. ESTIMATED RESERVES (MT):
3. METHODS TO BE USED: Mechanical
4. DESCRIPTION OF LOCATION OR ENVIRONMENT:
PRESENT STATUS OF THE PROJECT

Operational

Page 5 of 24
 MGB Form 29-16 (Series of 2014)

PREPARED BY: OFFICIAL DESIGNATION ADDRESS TELEPHONE NO.

BRIGIDO D. LIM PCO Purok San Roque, Sicayab, Dipolog City 9985696477
(Signature Over Printed Name)
CERTIFIED BY: OFFICIAL DESIGNATION ADDRESS TELEPHONE NO.

NOEL W. RECAMARA MGR/PERMITTEE Purok San Roque, Sicayab, Dipolog City 9985696477
(Signature Over Printed Name)

CERTIFICATION

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

NOEL W. RECAMARA PERMITTEE/MGR 1/4/2023

SIGNATURE OF REPORTING OFFICIAL OFFICIAL POSITION DATE

REPUBLIC OF THE PHILIPPINES)

DIPOLOG CITY ) S.S.
X- - - - - - - - - - - - - - - - - - - - - - - - -/

Subscribed and sworn to before me this 1st day of April, 2023, the affiant exhibited to me his LTO Driver’s License No JO1-86-004511.

DOC NO.
PAGE NO
BOOK NO.
SERIES OF 2023

Page 6 of 24
 Republic of the Philippines
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Mineral Economics Information and Publication Division
North Avenue, Diliman, Quezon City

INTEGRATED ANNUAL REPORT OF METALLIC MINERALS, NON-METALLIC MINERALS AND

For the Report Year : 2017

NAME OF COMPANY/LICENSE/PERMITTEE: NOEL W. RECAMARA

ADDRESS (Mailing address): PUROK SAN ROQUE, SICAYAB, DIPOLOG CITY

PART I - MINING COMPANY INFORMATION

Permit or Contract Number: IP-024-13-X Date Established: October 3, 2015 Tax Account Number:
COMPANY NAME - (Write below the correct name of company if it is not the same as in the address box. If name of person, write surnam
ISAG - NOEL W. RECAMARA / Riversand Enterprises and Services
ADDRESS (Write the correct address if it is not the same as in the address box)

Telephone Number: (Write only one telephone number and one local number)
Cell No. 09985696477 Local No.: None Fax No.: None E-mail Address: brigidodiaolim@gm
FORM OF OWNERSHIP: (Indicate if Single Proprietorship, Partnership, Corporation, Cooperative, Association or Government)
Single Proprietorship
PERCENTAGE OF OWNERSHIP: (Indicate in percent if Filipino, Canadian, American, Chinese, Japanese, British,Spanish based on capital invested
100% Filipino
NAME OF MANAGING OFFICIAL: POSITION:
NOEL W. RECAMARA Mana

PART 2 - OPERATING EXPENSES AND OTHER CHARGES

(Please write all expenses incurred by the HEAD OFFICE solely on mining operations/activities.

1. OPERATING EXPENSES
1.1 Salaries and Wages
1.2 Supplies Expense
1.3 Repair and Maintenance of
Buildings & Equipment
Expense (fees received by
1.4 Utilities
others)
1.5 Insurance Payments (excluding
those related to employment)
1.6 Marketing Expense
1.7 Telephone, Telegraph, Postage &
Other Communication Expenses
1.8 Transport Expense
1.9 Legal, Accounting,, Auditing &
Other Professional & Business Services
2. DEPRECIATION CH
Fees
3. INTEREST EXPENSE
P 126.00 1.10 Commission Expense
24.00 1.12 Donations and Contributions (SDMP)
- 1.13 Cost of Assets Sold in the Same Conditions as
Purchased
54.00 1.14 Royalties outside of those paid Under Taxes
24.00 1.15 Rentals Expense Outside of Those Paid Under
Taxes
- 1.16 Provisions for Bad Debts
28.80 1.11 Cost of Activities, such as Construction &
Exploration,
1.17 OthersContracted or Sub-Contracted
above (specify) to other
- not included
Companies/Entities
10.00 TOTAL (1.1 to 1.17) P
P 78
P 132

PART 3 - TAXES PAID IN FY 2017, Value in Thousand Pesos ('000)

1. NATIONAL IMPOSITIONS
1.1 Excise Tax on Mi 162.85 1.7 Other National Taxes (Specify)
 1.2 Income Tax 26.84 A. Fringe Benefit Taxes
1.3 Customs Duties/Fees - B. Percentage Tax
1.4 Value added Tax - C. Bus. Registration
1.5 Capital Gains Tax - D. Other National Taxes and Fees
1.0 Total National Taxes (1.1 to 1.7)
1.6 Documentary Stamp Tax -
P

2. LOCAL IMPOSITIONS
2.1 Real Property Ta 22.00 2.7 Wharfage Fees
2.2 Local Business Tax 20.96 2.8 Sand & Gravel Tax
2.3 Occupation Fees - 2.9 Extraction Fees
2.4 Community Tax 0.32 2.10 Other Local Taxes (Specify)
2.5 Registration Fees 1.50 2.10.1
2.0 Total Local Taxes (2.1 to 2.10)
2.6 Permit Fees 5.20
P

3. WITHHELD TAXES
3.1 W/T on Payroll - 3.7 W/T on Royalty for Transfer of Technology
3.2 W/T on Royalties on Claim / - 3.8 Other Withheld Taxes (Specify)
Surface Owners
3.3 W/T on /Dividends 3.8.1
-
3.4 W/T on Profit Remittance to Mo - 3.8.2
3.5 W/T on Interest Income - 3.8.3
3.6 W/T on Interest Payments 20.00 3.0 Total Withheld Taxes (3.1 to 3.8)

GRAND TOTAL (1.0 + 2.0 + 3.0)

4. ROYALTY PAYMENTS -
4.1 Government / Mineral Reserv -
4.2 Claimowners and/or Surfac -
4.3 Indigenous Peoples -

PART 4 - FIXED ASSETS AND CAPITAL EXPENDITURES

Report the value in thousand pesos ('000) of all fixed assets of the HEAD OFFICE. Include improvements on land such as culverts, sid
structures. Include also value of tools which last for more than a year, value of all equipment used for transporting persons, freight and othe
filing cabinets and others. Reserve for
Book Value at Beg. of Capital Expenditures Receipt
Depreciatio
Report Year Jan. 1, New/Ist from
n Dec. 31, Used/2nd Hand
2017 2017 Hand Sales
1. Land 1,000.00 - - - -
2. Buildings & Structur 1,000.00 20.00 - - -
3. Transport 700.00 70.00 - - -
Equipment
4. Office Equipment 31.00 - - - -
5. Furniture & Fixture 30.00 - -
6. Other Fixed Assets - - - - -
TOTAL (1 to 6) P 2,761.00 90.00 - - -

PART 5 - SUMMARY OF OUTSTANDING LOANS (Value in Thousand ('000))

 This refers to the amount of loans as of end of report year. Indicate in appropriate spaces provided the amount of l
Oustanding Amount of New Borrowings During Jan-Dec of Report Y
Loans at
End of Deferred Credits
SOURCES OF LOANS Report Year
Cash Loans
Dec. 31, Machinery & Equipment Raw Materials
2017
1. Foreign (specify count$0 $0 $0 $0

P
P
2. Local (specify source P P
Financing (RBR) 3,500.00 3,500.00
DBP 175.00 -
Banco Dipolog 120.00 -
3. Loan Repayments (Pri LOCAL : P 956,000 FOREIGN: $ 0

PART 6 - SUMMARY OF INCENTIVES AVAILED OF (Value in Thousand Pesos ('00

SOURCE / VALUE OF INCENTIVES AVAILED

NATURE OF INCENTIVES
Board of Investments Mines and Geosciences Bureau
1. Allowable Deduction - -
1.1 Accelerated Deduction of Organizational & - -
Pre-Operating Expenses
1.2 Accelerated Depreciation - -
1.3 Net Operating Loss Carry-Over - -
1.4 Deduction for Expansion Reinvestment - -
1.5 Double Deduction of Promotional Expenses - -
1.6 Double Deduction of Shipping Costs - -
1.7 Allowance for Investment In a Pioneer Enter - -
2. Tax-Exemptions - -
2.1 Compensating Tax On Imported Capital Equ - -
2.2 Import Duty On Imported Capital Equipment - -
2.3 Sales Tax (Pioneer Enterprise) - -
2.4 Advance Sales Tax On Imported Raw - -
Materials, Supplies,
2.5 Capital etc. (Pioneer Enterprise)
Gains Tax-Exemption - -
2.6 Tax-Exemption On Sale of Stock Dividends - -
3. Tax Credit - -
3.1 Tax Credit for Witholding Tax On Interest - -
Payments on Foreign
3.2 Tax Credit Loans Capital Equipment
On domestic - -
3.3 Special Tax Credit On Raw - -
Materials/Supplies
TOTAL (1 to 3) of Exported Finished Products P - -

PREPARED BY: OFFICIAL DESIGNATION ADDRESS

BRIGIDO D. LIM Bokkeeper Purok San Roque, Sicayab, Dipolog City

(Signature Over Printed Name)
CERTIFIED BY: OFFICIAL DESIGNATION ADDRESS

NOEL W. RECAMARA Manager Purok San Roque, Sicayab, Dipolog City

(Signature Over Printed Name)

MINE SITE PARTICULARS

 ANSWERS SHOULD REFLECT INFORMATION PERTAINING TO MINE SITE ONLY

PART 7 - MINE INFORMATION

SITE NAM REGION: PROVINCE:

Sand & Gravel Concession of Noel Recamara IX Zamboanga del Norte

Major Product (Enter only one major product per site) Date of First Operation
Gravel/Boulders Year: 2013Month: October Day: 3

MINING METHODS USED: (Enter only one mining method p

MILLING METHODS USED: (Enter only one milling method per block)
1. Equipment-based 1. Rock Crushing (Primary Crushing)
2. Manual or labor-based 2.
3. 3.
CAPACITY IN METRIC TON: (Mining 20,000 CAPACITY IN METRIC TON: (Milling)
SMELTER/REFINERY (LOCAL AND FORE N/A ESTIMATED RESERVE:
NAME OF
SHIPPING POINT (PHIL ADDRESS OF SMELTER/REFINERY/
SMELTER/REFINERY/BROKER/DESTINATION
N/A None N/A N/A
N/A None N/A N/A
N/A None N/A N/A
COMPANY CONTRACTED TO OPERATE THIS SITE (if any): None
NAME OF CONTACT PE N/A ADDRESS: N/A

PART 8 - TOTAL PRODUCTION

UNIT GROSS QUANTITY GROSS VALUE (000)

A. PRIMARY

3,357,800.00
Boulders, mixed, g-2 & sand Cu. Meter 16,789.00

B. BY-PRODUCTS

PART 9 - TOTAL EXPORT/ LOCAL SALE

COUNTRY
OF GROSS QTY GROSS VALUE
DESTINATI(Specify Unit Used) Pesos (P'000) Dollars ($'000)
ON
A. PRIMARY
Boulders (60% x 9,919) Local 5,951 3,868,150.00

B. BY-PRODUCTS
Mixed, G-2, Fine Sand Local 3,968 1,785,600.00 -

PART 10 - PRODUCTION COST: COST OF USED MATERIALS AND SUPPLIE

Report the value of materials and supplies used during the report year. Include industrial and non-industrial costs incurred by this site in
Value in thousand pesos ('000).
UNIT OF
HAULING, HANDLING & ADMINIS-
ITEMS MEASURE VOLUME MINING MILLING
STORAGE TRATION
(liter)
1. Grease and Lubrican PAIL 6.00 - 15.00 20.00 -
 2. Chemicals N/A N/A N/A N/A N/A N/A
3. Explosives N/A N/A N/A N/A N/A N/A
4. Spare Parts Piece 50.00 15.00 120.00 N/A
5. Containers and Packing Piece - - 10.00 -
6. Lumber N/A N/A N/A N/A N/A N/A
7. Steel Balls N/A N/A N/A N/A N/A N/A
8. Non-Durable Tools Piece - 10.00 20.00 -
9. Others Not Included Above
TOTAL COST OF USED MATERIALS AND SUPPLIES BY 50.00 40.00 170.00 -
CONVERSION RATE: (US $1.00 = P)

PART 11 - PRODUCTION COSTS: COST OF FUELS AND UTILITIES

Report the value of fuel and utilities consumed during the report year. Allocate accounts according to heading. Valu
1. COST OF FUELS (indicate if gas, gasoline, diesel oil, bunker oil, coal, etc)
UNIT OF
HAULING, HANDLING & ADMINIS-
MEASURE QUANTITYMINING (40%)
MILLING (20%) STORAGE (40%)
TRATION
(liter)
Gas Liter -
Gasoline Liter -
P38.41/ltr) Liter ### 276.60 138.00 276.00
Bunker
oil Liter -
Coal Liter -

TOTAL COST OF USED FUELS BY

276.60 138.00 276.00 -
SOURCE P
CONVERSION RATE: (US $1.00 = P)

2. COST OF UTILITIES
UNIT OF HAULING, HANDLING & ADMINIS-
QUANTITY MINING MILLING STORAGE
MEASURE TRATION
2.1 Water Liter - -
a. Purchased Liter 5,280 - 1.98 4.62
b. Generated Liter - - - -

2.2 Electricity KWH - - -

a. Purchased kwh 1,000 - - 24.00
b. Generated N/A 0 - - - -
b.1 By the above fu N/A - - - -
b.2 By Other Sourc N/A
3. Sold N/A
TOTAL (2.1 + 2.2 + 3) P - - - -

PART 12 - PRODUCTION COST: COST OF LABOR

Report number of persons who worked in or for this company, their basic salaries and wages, overtime pay and benefits for work done by
paid in cash and in kind prior to all deductions such as witholding tax, group insurance, union fees, etc. Value in thousand pesos ('000).

TYPE OF Number of EXTRA

Regularly SALARIES OVERTIM EXTRA BENEFITS PAID BENEFITS
REGULARLY-PAID SSS/GSIS
Paid & WAGES E PAY IN CASH PAID IN
EMPLOYEES Employees KIND

1. MINING - - -
 a. Skilled 1 132.00 - 5.00
b. Laborer -

2. MILLING
a. Skilled 2 237.60 10.00
b. Laborer 1 52.80

3. Hauling, Handling & Storage

a. Skilled 2 184.80 - - 10.00
b. Laborer

4. Administrative W 3 211.20 15.00

TOTAL (1 to 4) 9 910.00 - - 40.00 -

PART 13 - OPERATING EXPENSES AND OTHER CHARGES

Report the value of expenses of the MINESITE for the report year. Include industrial and non-industrial charges incurred in the operations

1. OPERATING EXPENSES
1.1 Marketing Expense
1.1.1. Smelter Charg - 1.1.4. Assaying & Analysis Charges
1.1.2. Refinery Charges - 1.1.5. Other Marketing Expenses
1.1.3. Freight Charges (Excludin - SUB-TOTAL (1.1.1 to1.1.5) P

1.2 General & Administrative Expenses

1.2. 1. Repair & Maintenance of - 1.2.8. Cost of Assets Sold In The Same
Buildings
1.2.2. and equipment
Insurance (Fees
Payments 16.00 Condition as Purchased
1.2.9. Donations and Contributions
received
(excludingby Others)
those related Expense
to -
1.2.3. Transportation 1.2.10. Rentals Expense Outside of Those
employment)
(outside of production and freight 12.00 Paid UnderRoyalties
Taxes Outside of Those Paid Und
1.2.4. Telephone, Telegraph, 1.2.11.
charges)
Postage and Other Communication 10.00
1.2.5. Legal, Accounting, 1.2.12. Provision for Bad Debts
Expenses
Auditing
1.2.6.&Commission
Other Professional
Expense & - 1.2.13. Others Not Included Above (Specify)
Business Services Fees - SUB-TOTAL (1.2.1 to 1.2.13)
1.2.7. Cost of Activities such as P
Construction Contracted and Sub- TOTAL OPERATING EXPENSES (1.1 & 1.2) P
Contracted by Others

2. DEPRECIATION P 78,000
3. INTEREST EXPENSES P 354,000
4. DEPLETION CHARGES P 0
5. ENVIRONMENTAL COST -AEPE P 419,000
6. SOCIAL DEVELOPMENT COST P 344,300

PART 14 - FIXED ASSETS AND CAPITAL EXPENDITURES

Report the value of fixed assets of the MINESITE. Include improvements on land such as culverts, sidewalks, walls, roads, waiting sheds
which last for more than one year, value of all equipment used
Reserve for for transporting persons, freight and other materials, office equipment, drinkin
Capital Expenditures
Book Value at Beg. of Receipt
thousand pesos ('000). Depreciatio
Report Year Jan. 1, New/Ist from
n Dec. 31, Used/2nd Hand
2017 2015 Hand Sales
1. Land 600.00 - - - -
2. Mining Property and - - - - -
3. Buildings & Structur 400.00 9.70 - - -
4. Machineries & Other 2,000.00 200.00 2,000.00
Production Equipment
5. Transport Equipmen 3,000.00 300.00 3,000.00
6. Pollution Control De 15.00
 7. Other Fixed Assets 25.00
TOTAL (1 to 7) P 6,040.00 509.70 - 5,000.00 -

PART 15 - SUMMARY OF CONTRACTED AND SUB-CONTRACTED ENTITIE

Report the names of the companies/entities contracted to perform certain
NAME OF COMPANY/ENTITY NATURE OF JOB
1. NONE N/A
2. NONE N/A
3. NONE N/A

PART 16 - REPORT ON PROBLEMS ENCOUNTERED

Describe the problems encountered in the mine site with respect to the specified areas listed b
1. RAW MATERIALS, POWER, FUEL
none
2. POLLUTION CONTROL
none, so far
3. MACHINERIES AND EQUIPMENT
machine breakdown, availability of spare parts, high cost of repair & maintenance
4. FINANCE AND CREDIT
financing rates are high in private finance institutions
5. GOVERNMENT POLICIES/REGULATIONS
Rigid
6. OTHERS
typhoons/continued heavy rains in 2017 disrupts extraction activity

PART 17 - EXPLORATION PROJECTS

Indicate the type of projects whether for diamond drilling, aditing/tunnelling, geology or assaying & analysis charges. Name the location,
thousand pesos for each type of project. Ore Reserves Meterage
Location
Positive Probable Possible Advance
A. Minesite Exploration N/A

B. Outside Exploration Pr N/A

PART 18 - EXPANSION PLANS / NEW PROJECTS WITHIN OR OUTSIDE THE MINE SITE/No

SITE NAME: REGION: PROVINCE:

N/A N/A
Major Product (Enter only one major product per site) Target Date of Ope
Year: Month:
CAPACITY IN METRIC 1) MINING 2) MILLING:
PROJECT COSTS: (Name the specific COSTS INCURRED by this Project)

PERCENTAGE OF OWNERSHIP: (Name the specific NATIONALITIES that will participate in this project; include their PERCENTAG
N/A
GOVERNMENT LOANS / INCENTIVES:
GOVERNMENT INSTITUTION / AGENCY NATURE OF LOANS / INCENT
N/A N/A
EMPLOYMENT GENERATION
TYPE OF EMPLOYEES NUMBER
N/A N/A

PROJECT DESCRIPTION: N/A

1. TYPE OF PROJECT:
2. ESTIMATED RESERVES (MT):
3. METHODS TO BE USED:
4. DESCRIPTION OF LOCATION OR ENVIRONMENT:
PRESENT STATUS OF THE PROJECT
On-going

PREPARED BY: OFFICIAL DESIGNATION ADDRESS

BRIGIDO D. LIM Bookeeper Purok San Roque, Sicayab, Dipolog City

(Signature Over Printed Name)
CERTIFIED BY: OFFICIAL DESIGNATION ADDRESS

NOEL W. RECAMARA MGR/PERMITTEE Purok San Roque, Sicayab, Dipolog City

(Signature Over Printed Name)

CERTIFICATION

I hereby certify that all information in this report are complete,true and correct to the best of my knowledge and be

NOEL W. RECAMARA PERMITTEE/MGR

SIGNATURE OF REPORTING OFFICIAL OFFICIAL POSITION

REPUBLIC OF THE PHILIPPINES)

DIPOLOG CIT ) S.S.
X- - - - - - - - - - - - - - - - - - - - - - - - -/

Subscribed and sworn to before me this 22nd day of January, 2018, the affiant exhibited to me his BIR Tax Identifi
No. 905-860-866, as proof of his identity.

DOC NO.
PAGE NO
BOOK NO.
SERIES 2018
 MGB Form 29-16 (Series of 2014)
Philippines
and Natural Resources
NCES BUREAU
and Publication Division
n, Quezon City

NON-METALLIC MINERALS AND QUARRY RESOURCES

ear : 2017

ANY INFORMATION

Tax Account Number: 905-860-866

ress box. If name of person, write surname first.)

E-mail Address: brigidodiaolim@gmail.com

ve, Association or Government)

ese, British,Spanish based on capital invested as of the end of reported year.)

POSITION:
Manager/Proprietor

ES AND OTHER CHARGES

mining operations/activities. Value in Thousand Pesos ('000))

-
344.30
-
-
-
-
-

611.10

Value in Thousand Pesos ('000)

 -
104.15
0.50
-
294.35

-
-
900.00
-

949.98

-
-
-
-
-
20.00

1,264.33

APITAL EXPENDITURES
mprovements on land such as culverts, sidewalks, wall, roads, waiting sheds and other
for transporting persons, freight and other materials, office equipment, drinking fountain,

Book Value at End of Report Year Dec. 31, 2017

1,000.00
980.00
630.00
31.00
30.00
-
2,671.00

G LOANS (Value in Thousand ('000))

propriate spaces provided the amount of loan according to source.
orrowings During Jan-Dec of Report Year 2017
Deferred Credits

Raw Materials Guarantee/ Security

$0 $0

P P
- -
- -
- -

LED OF (Value in Thousand Pesos ('000))

SOURCE / VALUE OF INCENTIVES AVAILED OF

Other Agencies
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

TELEPHONE NO.

9985696477

TELEPHONE NO.

9985696477

TICULARS
PERTAINING TO MINE SITE ONLY

FORMATION

MUNICIPALITY:
Dapitan City
Change
0

r only one milling method per block)

hing)

10,000
N/A
ADDRESS OF SMELTER/REFINERY/BROKER DESTINATION
N/A
N/A
N/A

N/A

RODUCTION

AVERAGE GRADE

N/A

ORT/ LOCAL SALE

AVERAGE GRADE

N/A

N/A

F USED MATERIALS AND SUPPLIES

on-industrial costs incurred by this site in its operations. Allocate accounts to headiing.

TOTAL

35.00
 -
-
185.00
10.00
-
-
30.00
-
260.00

OST OF FUELS AND UTILITIES

cate accounts according to heading. Value in thousand pesos ('000).

TOTAL

-
-
690.60
-
-

690.60

TOTAL

6.60
-

24.00
-
-
-

30.60

OST: COST OF LABOR

vertime pay and benefits for work done by regularly paid employees within the report year,
etc. Value in thousand pesos ('000).

TOTAL
 137.00
-

247.60
52.80

194.80
-

226.20
858.40

ES AND OTHER CHARGES

on-industrial charges incurred in the operations. Value in thousand pesos ('000).

-
-
-

-
344.30
-
-
-

382.30
382.30

CAPITAL EXPENDITURES
rts, sidewalks, walls, roads, waiting sheds, and other structures. Include value of tools
other materials, office equipment, drinking fountains, filing cabinets and others. Value in
Book Value at End of Report Year Dec. 31, 2015

600.00
-
390.30
1,800.00
2,700.00
15.00
 25.00
5,530.30

AND SUB-CONTRACTED ENTITIES

ties contracted to perform certain
NATURE OF JOB

BLEMS ENCOUNTERED
with respect to the specified areas listed below

TION PROJECTS
& analysis charges. Name the location, type of reserves, meterage advance and cost in

Cost ('000)

-
-
-

-
-

N OR OUTSIDE THE MINE SITE/No plan for expansion

MUNICIPALITY:

Target Date of Operation

Month: Day: -

this project; include their PERCENTAGE OF OWNERSHIP)

NATURE OF LOANS / INCENTIVES

 NUMBER

TELEPHONE NO.

9985696477

TELEPHONE NO.

9985696477

o the best of my knowledge and belief.

1/22/2018
DATE

exhibited to me his BIR Tax Identification ID