Republic of the Philippines

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES

MINES AND GEOSCIENCES BUREAU

CHECKLIST OF REQUIREMENTS
CONVERSION OF EXPLORATION PERMIT
TO MINERAL PRODUCTION SHARING AGREEMENT
NAME OF APPLICANT:
CONTACT PERSON/ADDRESS:

EP No.: DATE ISSUED:

COMMODITY: LOCATION:
AREA:
DATE FILED: DATE RECEIVED BY C.O.:

REQUIREMENTS REMARKS
A. Mandatory Acceptance Requirements
1. Proof of payment of Conversion Fee [ ]

2. Letter of Intent requesting for conversion of the EP to [ ]

MA

3. Two (2)-Year Exploration Work Program (MGB Form [ ]

No.5-4)

4. Geologic Report showing a resource discovery [ ]

5. Affidavit of Undertaking (using MGB Form) [ ]

B. Additional Requirements after Acceptance of

Application

1. MGB-registered Secretary’s Certificate attesting to a []

Board Resolution authorizing the President to sign
and execute documents in connection with the MPSA
application

2. Environmental Work Program (MGB Form 16-1) []

3. Field verification report by the MGB Regional Office []

concerned confirming the resource discovery

4. Certification from the MGB Regional Office []

concerned as to the compliance with the terms and
conditions of EP

Additional Remarks:

Checked by:
Name and Signature Date