Form No.

008-TD
Revised as of 2/24/2021

Republic of the Philippines

Department of Transportation
LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
East Avenue, Diliman, Quezon City

PETITION FOR CANCELLATION OF FRANCHISE AND UNIT

Denomination_______________
No. of Units ________________
Route/Area of Operation____________________________

NAME OF APPLICANT: _______________________________ CASE NO. __________

Authorized Representative:

HOME/BUSINESS ADDRESS: _________________________________________________

TELEPHONE NUMBER: _______________ EMAIL ADDRESS: ________________

CITIZENSHIP: ______________________

AUTHORIZED UNIT DETAILS:

MAKE MOTOR NO. CHASSIS NO. PLATE NO. YR. MODEL CASE NO.
_______ ________________ ____________ __________ _________ ________

ATTACHMENTS:

Valid Government ID of Applicant (Annex ____)

or Authorized Representative

For Corporation/Partnership/Cooperative
Board Resolution/Sec. Certificate of
Authorized Signatory to sign and/or file
the Petition (Annex ____)

Additional attachments:
LTO OR/CR of Authorized unit/s (Annex ____)
Return Receipt of Plate License (Annex ____)

If w/o RRPL
LTO Certification of No Hire Plate issued (Annex ____)

If Plate License is Lost

Affidavit of Loss of Plate (Annex ____)
PNP Certification (Annex ____)
LTO Certification of No Alarms & Apprehension (Annex ____)

I hereby CERTIFY under oath that the information provided in the Petition is true and
correct. I/We, further CERTIFY that any false representation hereby made shall automatically
cause the denial of the Petition, without prejudice to other penalties as may be determined by the
Board.

_____________________
Petitioner