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    Mgbform5 1

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    ROLAND JOIE GELI
    This document is an application form for an exploration permit from the Mines and Geosciences Bureau of the Philippines. It requests information about the applicant such as name, address, capitalization, citizenship and percentage of stock holdings. It also asks for details about the mineral commodity to be explored, location and area of the applied exploration site. The applicant agrees that any false statements could lead to cancellation of the permit. It must be notarized and multiple copies submitted to the appropriate MGB offices.

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    Mgbform5 1

    Uploaded by

    ROLAND JOIE GELI
    127 views2 pages
    This document is an application form for an exploration permit from the Mines and Geosciences Bureau of the Philippines. It requests information about the applicant such as name, address, capitalization, citizenship and percentage of stock holdings. It also asks for details about the mineral commodity to be explored, location and area of the applied exploration site. The applicant agrees that any false statements could lead to cancellation of the permit. It must be notarized and multiple copies submitted to the appropriate MGB offices.

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    This document is an application form for an exploration permit from the Mines and Geosciences Bureau of the Philippines. It requests information about the applicant such as name, address, capitalization, citizenship and percentage of stock holdings. It also asks for details about the mineral commodity to be explored, location and area of the applied exploration site. The applicant agrees that any false statements could lead to cancellation of the permit. It must be notarized and multiple copies submitted to the appropriate MGB offices.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    127 views2 pages

    Mgbform5 1

    Uploaded by

    ROLAND JOIE GELI
    This document is an application form for an exploration permit from the Mines and Geosciences Bureau of the Philippines. It requests information about the applicant such as name, address, capitalization, citizenship and percentage of stock holdings. It also asks for details about the mineral commodity to be explored, location and area of the applied exploration site. The applicant agrees that any false statements could lead to cancellation of the permit. It must be notarized and multiple copies submitted to the appropriate MGB offices.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    MGB Form No.

    05-1

    Republic of the Philippines


    Department of Environment and Natural Resources
    MINES AND GEOSCIENCES BUREAU
    North Avenue, Diliman, Quezon City

    APPLICATION FOR EXPLORATION PERMIT

    Application No. _____________


    Applicant : _________________________________________________________
    Address : _________________________________________________________
    Business Phone/Fax Nos.: ________________________________________________

    For Corporation, Partnership, Association or Cooperative:


    Name Position

    ______________________________ ____________________________________
    ______________________________ ____________________________________
    ______________________________ ____________________________________
    ______________________________ ____________________________________
    ______________________________ ____________________________________
    ______________________________ ____________________________________
    ______________________________ ____________________________________
    ______________________________ ____________________________________

    Capitalization:
    Authorized P _______________
    SubscribedP _______________
    Paid-Up P _______________

    Citizenship of Stockholders and Percentage of Holdings


    Nationality Subscribed Paid- Up
    Filipino ______% ______%
    American ______% ______%
    Canadian ______% ______%
    Australian ______% ______%
    Others, pls. specify_________ ______% ______%

    Mineral Commodity Applied __________________________


    Area to be explored ___________________ hectares
    Location of Applied Area __________________________________________
    (Please indicate the technical description of the area in a separate sheet
    to be attached as Annex “A” of this document.)

    In accordance with the provisions of the Philippine Mining Act of 1995 and
    DENR Administrative Order No. 96-40 otherwise known as the Revised Implementing
    Rules and Regulations promulgated thereunder, I, _________________________ for and
    in behalf of _______________________________ hereby applies for Exploration Permit
    on the areas described herein, subject to the following:

    1. The statements made in this application or made later in support thereof, shall be
    considered as conditions and essential parts of the permit that may be granted by
    virtue thereof and any falsehood or omission of facts which may alter, change, or
    affect substantially the facts set forth in said statements shall be sufficient cause for
    the cancellation of the Permit when granted.

    1
    MGB Form No. 05-1

    2. The applicant further agrees to submit additional requirements that the Regional
    Director concerned deems necessary for purposes of determining his qualification for
    the grant of the Permit applied for.
    3. The application is filed for the exclusive use and benefit of the applicant and not
    either directly or indirectly for the benefit of any other person, corporation or
    partnership and the area is applied for the sole purpose of exploration, and not for
    speculation.
    4. The foregoing statements are hereby certified to be true to the best of the applicant’s
    knowledge and belief.
    6. The application fee of ________________________________ had been paid under
    Official Receipt No. ____________ dated _____________________, 19____, at
    _______________________.
    I ______________________, the person executing this affidavit for this
    application, being first duly sworn, depose and say: that I have read or have caused the
    foregoing application to be read to me, that I thoroughly understand the same; that each
    and every statement in said application is true and correct.

    _____________________________
    Applicant
    TIN_________________________

    ACKNOWLEDGEMENT

    Republic of the Philippines _____ )


    Province of ________________ ) S. S.
    City/Municipality of _________ )

    SUBSCRIBED AND SWORN to before me at the place aforesaid, on this


    __________ day of ____________________, 19_____. The affiant exhibited to me
    his/her Community Tax Certificate No. ____________ issued at ___________ on the
    ___________ day of _______________, 19____.

    ___________________________
    NOTARY PUBLIC
    Until Dec. 31, 19 ______
    PTR No. ____________
    Doc. No. _______
    Page No. _______
    Book No. _______
    Series of _______
    INSTRUCTION

    1. This application shall be accomplished in quintuplicate, two copies to be retained by


    the applicant, one copy to be forwarded to the MGB Central Office and the remaining
    copies for the MGB Regional Office.
    2. All pertinent information required shall be given, inapplicable words, cancelled and
    all blanks shall be filled up.
    3. Application not accompanied with all the required documents shall not be accepted.

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