Insular Government Property Sales Application

DENR application form for land management services

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Environment and Natural Resources
Land Management Division
2nd Floor, L & S Bldg. 1515 Roxas boulevard
Ermita, Manila
Note: This application must be submitted in duplicate, otherwise it will not be accepted.

Application No. ________________________

I HEREBY make application to purchase for agricultural, residential, commercial,
industrial, charitable, educational or religious purpose under the provisions of Chapter V,
IX, X or XI of Commonwealth Act No. 141 (Public Land Act), as amended; the following
tract of public land (if the land is a subdivision or cadastral lot, mention the lot and survey
number), Lot .__________Block No. _________ Psd-___________________,
Phase_______ situated in the Barangay of ____________________, Municipality of
___________, Province of Metro Manila, Island of Luzon, Philippines and containing an
area of __________square meters sketch of which is drawn on the back hereof.

2. My name is ___________________________________, my age is ______ years, my
birthplace is _________________________________, the date of my birth is
________________________. I am a citizen of the Philippines and my post office
address is _________________________________________, I am (married, single)
and the name of my wife/husband is ________________________________, who is a
citizen of the Philippines. (If the applicant a married woman, a written consent of her
husband should be attached to her application).
3. I have been upon and examined the land applied for and it contains no improvement or
indication of occupation or settlement, except as follows:
__________________________________ and to the best of my knowledge and belief,
it is neither timber nor mineral land and contains no valuable deposit of guano, coal or
4. This application is made in good faith for my exclusive benefit and use and not, either
directly or indirectly for the benefit or use of any other person, corporation, association or
partnership, but for the actual purpose of using the land solely for residential purposes,
5. Then land applied for is/is not mortgage with the ____________________________
copy of the Deed of Mortgage of which is hereto attached.
6. The said lot is/is not tenanted by or leased to anybody, copy of the agreement of the
tenants or lease of which is hereto attached.
7. I agree to conform to future delimitation, classification, survey or re-survey of the land
herein applied for and I shall before patent/deed of conveyance/deed of sale is issued to
me accept such portion or portions as may be assigned to me by the Director of Lands
as a result of such new delimitation classification, survey or re-survey.
8. I agree that a strip of forty meters wide starting from bank on each side of any river or
stream that may be found on the land shall be demarcated and preserved as permanent
timber land be planted exclusively to trees of known economic value, and I shall not
make any clearing thereon or utilized the same for ordinary farming purposes even after
patent shall have been issued to me. (NOTE: Not applicable if Land applied for is for
residential, industrial or commercial purposes).

9. I understand that this application conveys no right to occupy the land prior to the award
of the land to me; that the land is of the public domain and that any and all rights I may
have respect thereto by virtue of continuous occupation and cultivation are hereby
relinquished to the Government.
10. I have read or someone has read to me, and I understand the provision of the Public
Land Act relating to the entering and granting through purchase of land of the public
domain of the Philippines and I will faithfully and honestly endeavor to comply with all the
requirements of the law on the subject or sale.
11. I am _________________________ a member, stockholder, officer, representative,
attorney, agent, employee or bondholder of the following corporations, association or
partnership which are engaged in agriculture and are holders of agricultural public lands
in the Philippines (give the name of the corporation, association or partnership, their
. The said corporation, association or partnership has under its control a total area of
________________ hectare of public land by virtue of its ________________________.
12. I understand that any applicant who willfully and knowingly submits false statement or
execute false affidavit in connection with this application shall be deemed guilty of
perjury and shall be punished accordingly and that any person who; not being qualified
to apply for public land, files an application or induces/permits another to file it in his
behalf shall be punished by a fine of not more than five thousand pesos and by
imprisonment for not more than five years or both and in addition thereto his application
shall be rejected or cancelled and all amounts paid on account thereof forfeited to the
Government, and he shall not be entitled to apply for any public land in the Philippines.

Signature of Applicant
Republic of the Philippines)
Province of ____________)S. S.
Municipality of _________)
I, ________________________________________________ the person making this
application first having duly sworn upon both depose and say: That I have read or someone
has read to me and I thoroughly understand the foregoing application; that I have and this
affidavit in the presence of the officer who administered the oath; and that each and every
statement in the application is true and correct. SO HELP ME GOD.

Before me, at the place aforesaid, on this _____ day of ________, 20_____ personally
appeared ________________, known to be the person whose name appears in the foregoing
application and who subscribed and sworn to this affidavit. He/She exhibited to me his/her Res.
Cert. No. ____________ Issued at ___________________________ on the _____ day of
_____________, 19___ which shown him/her on the date of said certificate to be
_________________years old.

Officer authorized to administered oath