[ COMPANY LETTERHEAD]

[ DATE ]

WILSON L. TRAJECO
Regional Director
ENVIRONMENTAL MANAGEMENT BUREAU -
REGION 3
Masinop Corner Matalino St., Diosdado Macapagal Government Center, Maimpis, San Fernando
City, Pampanga

SUBJECT : AUTHORIZATION

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

Gov’t ID # : _____________________ ,
Company ID # : ______________________ ,
Hereby authorize MR/MRS. _________________________________ 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 ______________________________________________. Any and all acts carried out by
Mr./Mrs. _________________________________________ on my behalf shall have the same effect
as acts of my own.
Hoping for your kind consideration
Thank you.

[ Signature over Printed Name ]

Senders Name
Contact Number
Photocopy of Senders ID attachment

SENDERS
GOVERNMENT ID SAMPLE

SENDERS
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