Annex A.

Application Form
( DAO 17-2007, July 25, 2007)

Republic of the Philippines

Department of Environment and Natural Resources
National Government Center, Sudlon, Lahug, Cebu City

SPECIAL USE AGREEMENT IN PROTECTED AREAS (SAPA)

Name of Protected Area: Taῆon Strait Protected Seascape

Application No. :_________________ Date Filed: _____________________________
Status : New _____ Renewal ____ Date Expired : ________________________
Name of Applicant : ____________________________________________
Address : ______________________________
Cel. No. : __________________ Email add:_______________________________

Type of Applicant:
________ Indigenous People
________ Tenured Migrant
________ Local Government Unit
________ Other Government Agency
________ Other interested Party

Type of Special Use Applied for (Pls. check appropriate box/es)

________ Ecotourism
________ Camp Site
________ Community facility
________ Transmission lines
________ Irrigation Canals/ Agriculture
________ Right –of- way
________ Aqua- culture
________ Monitoring Stations
________ Beach Resorts
________ Ports
________ Public Utility/Commercial vessels
________ bathing area/s
________ Other Special Uses (Pls. specify)

Brief description of Special Use Applied for:

Submitted by: Right thumb mark

(Name & signature of Applicant or duly authorized

Representative
ATTACHMENTS/ REQUIREMENTS
(for Corporation, Association, Partnership, Cooperative, Tenured Migrants or IPs)

___1. For tenured migrant/s, certification from the concerned CENRO

___2. For Corp. or Ass’n. copy of SEC registration, Articles of Inc. & by-Laws & a Resolution of the
Governing Board designating the authorized representative of the Corp. or association
___3. For Partnership, copy of the partnership.
___4. For a cooperative, a certificate of registration with the CDA.
___5. In case of application of non-tenured migrants within the PACBRMA areas for activities not
included in the CRMP, a MOA between the proponent and the PACBRMA holder
___6. Site Development Plan Perspective to include structural designs, building plans, road and drainage
and other similar plans & designs.
___7. Indicative Development Plan/ Comprehensive Dev’t. & Mgt. Plan ( Narrative Plan).
___8. Proof of financial capability to manage and develop the area applied for based on paid-up
capital and /or collateral real properties.
___9. A certified copy of the applicant’s Income Tax Returns for the past five (5) years. In case the
applicant has been in the existence for less than five years, the Income Tax Return(s) since its
registration shall be submitted.
___10. Free and Prior Informed Consent (FPIC) of concerned IPs and or Prior Informed Consent (PIC) of
concerned local communities Barangay and Municipality, when project is new, not existing.
___11. Sketch/Location Map.
___12. Notice of 15-dayPublication of the Application published/posted either in local daily news or
public conspicuous places within the vicinity of the applied area, Barangay Hall, municipal Hall,
when the applied area is open, no existing occupancy.
___13. Environmental Compliance Certificate (ECC) from Environmental Mgt. Bureau- DENR, where
applicable pursuant to Sec. 12 of R.A. 7586.

Checked and Verified by:

___________________________
Printed Name and Signature

Date Verified: _______________

___________________________________________________________________

Note:
Process Flow of Application

1. After completion of the requirements, PASu and LGUs concerned, where applicable, review the
documents, inspect the project site and present results to the TSPS - PAMB for approval or
denial.
2. Upon approval, PASu advises the proponent to proceed to apply and secure ECC from EMB-
DENR, where applicable and submit to the PASu.
3. Upon completion of all documents required, RED recommends to the DENR Secretary who signs
and approves the SAPA.
4. Resource Use fee shall be paid by the applicant after he/she agreed and signed the SAPA;
amount is based on the Resource Use Fee System of the Protected Area.