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30-1 Application for a Special Exploration Permit

MGB application form for special exploration permit

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

APPLICATION FOR A SPECIAL EXPLORATION PERMIT
(For FTAA Applications filed under DENR A.O. No. 63, Series of 1991)

1. Name of Applicant __________________________________________________
Address _________________________________________________________
Tel. No. ___________________________ Fax No. _____________________
2. Board of Directors and Officers:
Name
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

Position
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

3. Capitalization:
Authorized
Subscribed
Paid-Up

: ___________________
: ___________________
: ___________________

4. Citizenship of Stockholders and Percentage of Holdings:
Nationality
_____________________
_____________________
_____________________
_____________________
_____________________

Subscribed
________%
________%
________%
________%
________%

Paid-up
_______%
_______%
_______%
_______%
_______%

5. Area to be explored (hectares) : _______________________________________
6. Location of Applied Area:
___________________________________________________________________
___________________________________________________________________
(indicate on map of 1:250,000 scale together with technical description of area)
7. Minerals ____________________________________________________________

______________________________
Applicant/Authorized Representative
(signature over printed name)
_______________
Date

1
 
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