APPLICATION FOR SPECIAL LAND USE PERMIT (SLUP)
Application No. _____________
Regional Executive Director
Department of Environment and Natural Resources
Visayas Avenue, Diliman
Quezon City
Sir:
In consonance with the provision of P.D. 705 as amended, Executive Order No.192, Series of
1987, Executive Order No. 278, Series of 1987 and all pertinent regulations on the matter, I/We hereby
apply for a Special Land Use Permit, the particulars of which are as follows:
Type of Forest land Use: ___________________
Approximate Area: ___________________ ha.
Location: Province _____________________________
Municipality/City _____________________________
Barangay(s) _____________________________
Sitio(s) _____________________________
Boundaries: N :_________________________________________
E :_________________________________________
S :_________________________________________
W:_________________________________________
I/We understand that the filing of this application does not convey the right to enter, occupy
or develop the area applied for, until an permit has been executed between me/us and the Regional
Executive Director of the Department of Environment and Natural Resources.
All application requirements as stipulated in the regulation are enclosed together with the required
non-refundable application fee of P_______________ .
Very truly yours
_______________________________________ ________________________________
_______________________________________ (Applicant)
Postal Address
_______________________________________
Contact Number/s
REPUBLIC OF THE PHILIPPINES )
Province of ____________________ : S.S.
Municipality of _________________ )
SUBSCRIBED AND SWORN to before me this ______ day of ________ Affiant
exhibited to me his/her Residence Certificate Number A- ___________ issued at
_________________________ on _______________________.
Doc. No.________
Page No.________
Book No. _______
Series of 2016