PRLD.0002-B.

02

REPUBLIC OF THE PHILIPPINES

Department of Human Settlements and Urban Development

Kagawaran ng Pananahanang Pan tao at Pagpapaunlad ng Kalunsuran
NATIONAL CAPITAL REGION

REGISTRATION STATEMENT
(For Single Proprietorship)

I, , Filipino, of legal age, single / married, with

postal address and residence at ,
after being sworn in accordance with the law, do hereby state that:

1. I am engaged in the business of _ _ _ _ _ _ _ _ _ _ _ _ _ __

with capitalization of___________________

2. am the owner of certain parcel( s) of land located at

_ _ _ _ _ _ _ _ _ _ _ _ covered by TCTNo. (s) _ _ _ _ __
comprising an aggregate area of_ _ _ _ _ _ sq.m.

3. That I am developing said parcel(s) of land into a_ _ _ _ _ _ _ _ __

_ _ _ hereinafter called ____________(Type of Project)

4. As the owner, and _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , as the developer

(Name of Developer)

5. The project, I undertake to develop said project in accordance with the plans
approved by the _ _ _--..,-_....,--..,...--:---,--,--_ _ _ _ _ _ _ __
(Approving Institution)

6. Attached hereto is the Declaration of UDHA Compliance, pursuant to the

implementing rules and regulations and circulars issued under Section 18 of
Republic Act No. 7279.

(Fill-out the attached Declaration of UDHA Compliance form

for main subdivision project or compliance project)

7. My authorized broker(s) shall be _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

8. In my capacity as owner of the project, I bind myself to comply with all the
rules and regulations pertaining to this project and shall be held responsible
for all the facilities, improvement, infrastructures and similar form of
development hereon.
 PRLD.0002-8 .02

Date Place

Affiant

SUBSCRIBED AND SWORN to before me this _ _ _ day of_ _ _ _ __

20__ , affiant exhibiting to me issued in _ _ _ __
on _ _ __

NOTARY PUBLIC

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