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Republic of the Philippines

Department of Environmental and Natural Resources


National Capital Region
North Avenue, Diliman, Quezon City
Telephone No. 435-8880

WRPS Form No. 2


Series of 2015

APPLICATION FOR NON-CITES WILDLIFE EXPORT/RE-EXPORT/IMPORT CERTIFICATION

The Regional Director


DENR – National Capital Region
National Ecology Center, East Avenue
Quezon City

Thru: The ARD, Technical Services

Sir/Madam

I would like to request for the issuance of permit/certification for the following
species/items/articles of wildlife (fauna/flora) intended for export/re-export/import for purpose of
______________________________.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Common/Scientific Name Description of Parts or Derivatives Quantity/Weight
Including Identifying Marks
or Numbers (Age & Sex)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________________________________
TOTAL:
______________________________________________________________________________
Document Attached: _________________________________________________________________

The aforementioned specimen will be exported/imported on or before _________________________

Air Cargo Sea Cargo Postal Cargo (Mail)

Plane: Flt. No. Vessel: Voyage No. Carrier:


Port of Loading: Port of Loading: Postal Office:
Date of Loading: Date of Loading: Date of Posting:

Name of Exporter: _________________________________________________________________


Address: _____________________________________________________________________________
Tel. No.: ____________________ Fax No.:__________________ TIN No. __________________

Name of Importer: _________________________________________________________________


Address: _____________________________________________________________________________
Tel. No.: ____________________ Fax No.:__________________ TIN No. __________________

__________________________ __________________________
Signature of Applicant Verified by

__________________________
Position

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