HOUSING AND LAND USE REGULATORY BOARD

Expanded National Capital Region Field Office

th
6 Floor, Sunnymede IT Center, 1614 Quezon Avenue
South Triangle, Quezon City

APPLICATION FORM FOR ZONING CERTIFICATION

______________________________________________________________________________
1. Name of Applicant
______________________________________________________________________________
2. Address of Applicant
______________________________________________________________________________
3. Name of Owner
______________________________________________________________________________
4. Location of Lot (Street, Barangay, Municipality, Province)
______________________________________________________________________________
5. Total Area of Lot (in square meter)
______________________________________________________________________________
6. Right over Land
[ ] Owner [ ] Lessee [ ] Others (specify)
______________________________________________________________________________
7. Preferred mode of release of certification
[ ] pick-up [ ] by mail, addressed
to ________________________________________________________________________
[ ] owner [ ] Authorized Representative
______________________________________________________________________________
8. Signature of Applicant
______________________________________________________________________________
9. Signature of Owner
______________________________________________________________________________
10. Requirements
[ ] Vicinity Map drawn to an appropriate scale showing the property in question
and indicating appropriate landmarks
[ ] TCT (or any proof of ownership or right over the property) / Tax Declaration

O.R. Number : ________________

Date Issued : ________________
Amount Paid : ________________

Republic of the Philippines )

______________________ ) S.S.

SUBSCRIBED AND SWORN TO before me this _____ day of _______________________ 20 _____

In the municipality of ________________________, province of ______________________________
affiant of exhibited to me his/her Residence Certificate No. __________________________ issued at
_________________________on _____________________.

Doc. No. ___________

Page No. ___________
Book No. ___________ NOTARY PUBLIC
Series of ___________