24 September 2021

_______________________________________
Regional Director
ENVIRONMENTAL MANAGEMENT BUREAU -
REGION 2 (CAGAYAN VALLEY)
20 Pagayaya Road, Regional Government Center,
Carig Sur Tuguegarao City, Cagayan

SUBJECT : AUTHORIZATION

I, the undersigned, ___________________ with the following ID’s

Gov’t ID # : ,
Company ID # :
Hereby authorize (Name),(Offical Designation (Name),(Offical Designation) and (Name),(Offical
Designation), with the following ID’s
Gov’t ID # : ,
Company ID #:
to act on my behalf in all manners relating to the application, submission and processing in the EMB
Online services of our Company / Facility Name __________________________________________________________
which is located in REGION 2 (CAYAN VALLEY). Any and all acts carried out by
_________________________________________________ on my behalf shall have the same effect as acts of my
own.
Hoping for your kind consideration
Thank you.

_____________________________________
_____________________________________
Photocopy of Senders ID attachment