2. Notarized Affidavit of Loss for lost Student Permit
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Mineral Economics, Information & Publications Division
North Avenue, Diliman, Quezon City
MONTHLY REPORT ON PRODUCTION, SALES AND INVENTORY OF QUARRY RESOURCES (EXCEPT SAND & GRAVEL) & SMALL SCALE NON-METALLIC
REPORT PERIOD: MONTH ________ YEAR ______
1. This form must be accomplished in duplicate
2. Submit the original copy to MGB Central Office through the Mineral Economics, Information & Publications Division (MEIPD) , copy furnished the Concerned Region
within 15 working days after the end of each calendar month.
3. Submission of this report is in compliance with SECTION 270, CHAPTER XXIX, OF DENR AO 96-40 or the implementing rules and regulations of REPUBLIC ACT NO. 7942.
4. Information to be supplied by the reporting Contractor/Operator/Permit Holder should cover the period from the first day to the last day of the report month.
5. This report form must be accomplished by Contractors/Operators/Permit Holder of Mineral Agreements, FTAAs or Mineral Processing Permits producing non-metallic minerals.
6. Fill-up production portion of this form on a per quarry resource produced.
7. For any non-metallic minerals not included in the list, please fill up the form and specify the mineral.
8. Do not leave any of the requirements unanswered. If a requirement does not apply, write NA (Not Applicable). If the question is applicable but you have no answer, write NONE.
9. This document should be signed by the resident manager or equivalent position thereof.
10. This report should be duly notarized.
11. Use additional sheet if necessary
12. For any comments, suggestions or clarifications regarding this form please consult your nearest MGB Regional Office in your area
DEFINITION OF TERMS:
Contractor/Operator is composed of one Head Office and one or more Quarry Sites
Quarry Site refers to the location where mineral extraction takes place (Barangay, Municipality, Province)
Capacity refers to the capacity of the mill or processing facility used by the permittee/operator expressed in Metric Ton Per Day (MTPD).
Rated Capacity refers to the maximum fixed output of a mill or processing facility expressed in Metric Tons Per Day (MTPD). It is also the measure of the theoretical amount of material that can be
handled/recovered in any given time by the mill.
Actual Capacity refers to the attained capacity of the mill or processing facility in Metric Tons Per Day (MTPD). It also refers to the constant amount of material that can be recovered/handled
in a given actual time per day
Number of days in operation refers to the total number of days the company is in operation during the reporting period
Grade Analysis refers to the grade composition of the most important components of the mineral.
Production quantity refers to the total volume of mineral extracted during the reporting period expressed in Metric Ton (MT).
Production value r efers to the total value or gross output of mineral extracted during the reporting period as defined in Chapter 1, Section 5 of the Revised IRR of the Phil. Mining Act of 1995. (under the term "Gross Output")
Estimated extraction fee payable refers to an estimate of the total extraction fee to be paid by the permittee covering the production during the reporting period and based on the prevailing extraction fee rate in the
Sales quantity refers to the total volume of mineral sold during the reporting period expressed in Metric Tons (MT).
Sales value refers to the total value of mineral sold during the reporting period. This value includes all costs of production, taxes invoiced to purchasers, transport & trade mark-up.
Estimated excise tax payable refers to an extimate of the total excise tax on minerals to be paid by the permittee to the Bureau of Internal Revenue (BIR) covering the production during the reporting period and
based on the rate prescribed by Section 217 (b) of the Revised IRR of the Mining Act of 1995.
Page 1 of 3
MGB Form 29-11 (Series of 2000)
COVERAGE OF NON-METALLIC MINERALS
White clay or Kaolin
12. Shale Clay
13. Silica Quartz
14. Silica Sand
15. Bull Quartz
17. Precious and Semi-Precious Stone
19. Others (pls. Specify) ___________
PROCESSED MINERAL PRODUCTS (Figures will not be included in totals)
1. Hydrated Lime or Slaked Lime
3. Processed Marble
I. ADMINISTRATIVE DATA
NAME OF CONTRACTOR/OPERATOR - If name of person, please write surname first
TAX IDENTIFICATION NO. (TIN)
E-MAIL ADDRESS (if any)
DATE OF 1st OPERATION (if new)
SITE ADDRESS: (State Barangay, Municipality, Province)
II. PRODUCTION DATA (Use additional sheet if necessary)
MINERAL PRODUCT : (Specify)
NO. OF DAYS
Reasons for increase or decrease in production this month compared to the previous month: (pls. check appropriate answer below and use additional sheet if necessary)
Increase was due to:
Decrease was due to:
1. Increased price of 1. Lesser operating days
the mineral being
2.c Force Majeure (pls. specify)_______________________________
1.a Equipment breakdown (pls. specify)__________________________________________________
2.d Environmental Problems (pls. specify)______________________
1.b Unfavorable weather condition (state duration or other information)________________________
2.e Gov't preventive actions such as CDO (pls. specify)___________
2. Increased demand
1.c Collapse/slide in working areas (state area) )___________________________________________
2.f Financial Problems (pls. specify) ___________________________
1.d Labor or other strikes (state duration)________________________________________________
3. Others (pls. Specify) ______________________________________________
4. More operating days 2. Suspension due to
5. Others (pls specify)
2.a Low price of the mineral commodity produced
2.b Market Problems (pls. specify)_____________________________________________________
Page 2 of 3
MGB Form 29-11 (Series of 2000)
III. SALES/MARKETING DATA (Use additional sheet if necessary)
SALES AGREEMENT NO.
Unit of Measure
**Use bags for cement and cubic meters for marble
IV. EMPLOYMENT DATA
Report the number of persons engaged in work at the head office and quarry site during this month
TYPE OF EMPLOYEES
(Signature over printed name)
I hereby certify that all information in this report are complete, true and correct to the best of my knowledge and belief.
SIGNATURE OF REPORTING OFFICIAL
REPUBLIC OF THE PHILIPPINES)
Subscribed and sworn to before me this ______ day of ______________, 20 ___ , the affiant exhibiting his/her Community Tax Certificate No. ____________, issued at _______________,
on the ____________ day of __________________ 20______.
My Commission Expires on Dec. 31, 20___
PTR No. _________
Page 3 of 3
2. When your number is called, proceed to the transaction counters to submit all required documents to the Evaluator.
3. Proceed to the Phototaking/Signature Area to have your picture and signature taken when your name is called.
4. Proceed to the Cashier when your name is called to pay the necessary fees and obtain an Official Receipt.
Fees/License Student Permit
License/ Permit O
Duplication Fee P30.00
Computer Fee 52.80
5. Proceed to the Releasing Counter, present the Official Receipt and claim the temporary student permit/license.