REPUBLIC OF THE PHILIPPINES

Department of Transportation
LAND TRANSPORTATION FRANCHISING
AND REGULATORY BOARD
East Avenue, Quezon City

_________________________,
Applicant.

CASE NO.______________

For: Application for the Issuance

of a Certificate of Public
Convenience To Operate a
Transport Network Vehicle Service
(TNVS)

X-----------------------------------------------------X

APPLICATION
WITH PRAYER FOR THE ISSUANCE
OF PROVISIONAL AUTHORITY

COMES NOW, Applicant, unto this Honorable Board most

respectfully alleges that:

1. Applicant is a Filipino1 citizen / corporation existing and duly

organized and established under Philippine Laws and with
business address at
_______________________________________________2.

2. Applicant hereby applies for the issuance of a Certificate of

Public Convenience (CPC) to operate a Transport Network
Vehicle Service (TNVS) for the transportation of passengers
and freight within/on the route Metro Manila to any part of

1 A true and faithful machine reproduction of the Applicant’s Philippine Passport

issued by the Department of Foreign Affairs or the Certificate of Live Birth
issued by the Philippine Statistics Authority is hereto attached and marked as
ANNEX “A” to prove the fact of Filipino citizenship.
2 A true and faithful machine reproduction of the Certificate of Business

Registration issued by the Department of Trade and Industry is hereto attached

and marked as ANNEX “B” to prove that the Applicant is duly registered to
operate the service being applied for.

1
 Luzon accessible to motor vehicle traffic and vice versa with
the use of __________ (___) unit/s3, to wit:

MAKE/MODEL/YEAR MOTOR NO. CHASSIS NO. PLATE NO./

CONDUCTION
STICKER NO.

3. Applicant is financially capable to operate and maintain the

service being applied for.4

4. In addition, as a transition period for this type of service,

Applicant respectfully prays that the Honorable Board issue
a Provisional Authority (PA) pursuant to LTFRB
Memorandum Circular No. 2015-017-A.5

5. Moreover, Applicant state that he/she/it shall comply with all

the requirements of this Honorable Board and will strictly
abide with the existing Rules and Regulations of the Land
Transportation Franchising and Regulatory Board and its
Memorandum Circulars, as well as the Public Service Act,
and other pertinent laws and policies.

6. Furthermore, with the consideration and approval of this

Application with the issuance of Provisional Authority (PA),
public necessity and convenience will be promoted in a
suitable manner.

3 A true and faithful machine reproduction of the Certificate of Registration (CR)

and Official Receipt (OR)/Sales Invoice of the aforementioned motor vehicle/s
is/are hereto attached and marked as ANNEX “C” to prove existence and
compliance of the motor vehicle/s applied for.
4 The Operator’s Data Sheet with complete details and valid driver’s license of

authorized drivers, and Statement of Financial Capacity with Income Tax Return
duly filed with the BIR/Proof of Bank Deposit/Certificate of Registration issued
by the BIR/Audited Financial Statement prepared by a Certified Public
Accountant/any proof of financial capacity such as land title or ownership of
business are hereto attached and marked as ANNEXES “D” and “E”, to prove
financial capacity of the Applicants.
5 Applicant shall present and submit a copy of its passenger insurance policy

upon claiming its PA.

2
 PRAYER

WHEREFORE, it is most respectfully prayed unto this

Honorable Board that this Application with prayer for the issuance of
Provisional Authority (PA) for the issuance of a Certificate of Public
Convenience (CPC) to operate a Transport Network Vehicle Service
(TNVS) be accepted and considered. Thereafter, a Provisional
Authority and Notice of Hearing be issued as well as the decision
granting the Applicant the Certificate of Public Convenience.

Quezon City, __________________

___________________________
Applicant

WAIVER

I, _____________________________________________,
hereby grant/s authority to the Land Transportation Franchising and
Regulatory Board (LTFRB), to verify the authenticity of all the
documents herein submitted together with this Application with prayer
for the issuance of a Provisional Authority (PA) from both government
and private sources.

___________________________
Applicant

3
 VERIFICATION AND CERTIFICATION
AGAINST NON-FORUM SHOPPING

I
_______________________________________, Filipino/s
and with business address at
________________________________________, after having been
duly sworn to in accordance with law hereby depose and say that:

1. I am the Applicant in the above-entitled case;

2. I have caused the preparation of the foregoing Application
with prayer for the issuance of Provisional Authority (PA);
3. I have read the contents thereof and the same are true to the
best of my knowledge and belief;
4. I have not commenced any other action or proceeding
involving the same issues in any other LTFRB Office;
5. To the best of my knowledge, no such other application,
petition or pleading is pending therein;
6. If I learn of the same or similar application, petition, or
pleading has been filed or is pending, I shall report of such
fact within five (5) days therefrom to this Honorable Board.

___________________________
Applicant

SUBSCRIBED AND SWORN to before me this ________ day

__________ at ______________________________. Affiant
exhibited to me his/her/their/its Government Issued ID6
____________________________________ issued at
______________ on ________________________.

Doc. No._____;
Book No._____;
Page No._____;
Series of 2018.

6 A true and faithful machine reproduction of Applicant’s two (2) Government

Issued IDs are hereto attached and marked as ANNEX “F”.