MGB Form No. 08-1
Republic of the Philippines
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
North Avenue, Diliman, Quezon City
APPLICATION FOR
INDUSTRIAL SAND AND GRAVEL PERMIT (ISAG) NO. ______
______________, 19____
The Director of Mines
Thru the Mines Regional Officer
MGB Regional Office No. ____
__________________________
Sir:
In accordance with the provisions of the Philippine Mining Act of 1995 and the
revised Implementing Rules and Regulations, the undersigned _____________________
hereby applies for an Industrial Sand and Gravel Permit to extract and remove
____________________ cubic meters of materials authorized hereunder from a tract of
land bounded by the following:
POINT
LATITUDE
LONGITUDE
with an approximate area of __________________________ hectares.
The area applied for is in public and/or private land, lake, river, stream, creek or
other public waters (underline applicable term), located in the Sitio of
__________________, Barangay of _____________________, Municipality of
___________________________, Province of ____________________________,
Island of _________________, Philippines.
The applicant: Name: _______________________________________________
Address: _____________________________________________
O
In case of individual, must be a citizen of the Philippines, of legal age,
___________________________________________________________
(indicate civil status and if married, give name and citizenship of spouse)
O
In the case of partnership or corporation, must be duly registered and
incorporated under the laws of, and authorized to transact business in the
1
MGB Form No. 08-1
Philippines, at least sixty per centum (60%) of the capital stock of this
partnership, corporation shall be owned and held by citizens of the
Philippines. A certified copy of the SEC Registration, Articles of
Partnership or Incorporation shall be submitted herewith.
Attached also are the following supporting papers:
O
Clearance, when required, from the Bureau of Public Works, Bureau of Public
Highways, National Power Corporation, National Irrigation Administration and/or
other government agencies, that the proposed excavations in the area applied
for will not adversely affect or cause damage to existing public and private
properties, multipurpose dams, reservoirs, seawalls, dikes, bridges, buildings,
highways and other infrastructures;
O
Written consent of owners of the private lands adjoining the area that may be
affected by excavations to be undertaken;
O
Commitment to secure Environmental Compliance Certificate (ECC) prior to
extraction.
The applicant binds himself or itself to pay the amount of __________________
(P___________) covering the total fee for the materials applied for, and to file a
_____________ bond in the amount of _________________, (surety, cash or personal)
(P_______); and to strictly and fully comply with all existing laws, rules and regulations,
orders, instructions, resolutions and ordinances governing the filing and approval of
application and the granting of the permits for the removal or taking of the materials
herein applied for. Failure to do so shall cause the cancellation of the permit and the
confiscation and forfeiture of the bond and all the payments, if any, made by the Permit
Holder, in favor of the Government. This application is made for the exclusive use and
benefit of the applicant and not either directly or indirectly, for the benefit of any other
person, corporation, partnership, and for the sole purpose of removing and disposing of
the said materials in the manner stated above. All the statements in this application shall
be considered as integral part of the Permit to be issued to him.
The above statements are true and correct to my best knowledge and belief.
Very respectfully,
__________________________
(Applicant)
TIN ______________________
2
MGB Form No. 08-1
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, the original to the MGB Regional Office, one copy to the Office
of the Governor and the remaining copy to be forwarded to the Provincial/City
Mining Regulatory Board.
2.
All pertinent information required shall be given, inapplicable word canceled, and
all blanks shall be filled up.
3.
Application not accompanied with all the required documents shall not be
accepted.
3