Form No.

013: with hearing

Revised as of 5/10/2021

REPUBLIC OF THE PHILIPPINES

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

______________________________ CASE NO.__________________

Applicant.

Application for Extension of Validity

to Operate a ___________________.
X--------------------------------------------x

APPLICATION

Applicant, most respectfully request for the extension of a Certificate of a Public Convenience
(CPC) to operate a ____________ Service and, in support thereof, states that:

1. Applicant, which may be served with legal processes at (address)/email address:

______________ and contact details (mobile number), is a grantee of a Certificate of
Public Convenience under the above case number, for the operation of _____ Service on
the route: __________________________________ which CPC is valid until
________________with the use of ______________ unit, to wit:

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

X- Nothing Follows –X

2. Applicant is financially capable to operate as ________________ Service.

3. Applicant will comply with all the requirements of this honorable board and will abide
with the existing LTFRB rules and regulations, the public service act, and other pertinent /
policies.

4. Applicant has completed the necessary documentary requirements for the Application,
copies of which are hereto attached in Annexes.
.
5. With the consideration and approval of this Application, public necessity and convenience
will be promoted in a suitable manner.

PRAYER

WHEREFORE, it is most respectfully prayed that (a) a Notice of Hearing be issued, (b)
this Application for Extension of Certificate of Public Convenience to Operate a ________
Service be accepted, considered and approved for the same authorized route with the use of the
same number of unit/s for a period that this Honorable Board may deem to fit and proper.

Other reliefs just and equitable under the premises are likewise prayed for.

Quezon City, Metro Manila, ___________________

Applicant
 WAIVER

I, ______________________________________, hereby grant authority to LTFRB, to

verify the authenticity of all documents herein submitted together with this application from both
government and private sources.

Applicant

VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I, ___________________________________, Filipino 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 forgoing application;
3. I have read the contents thereof and the same are true to the best of my knowledge and
belief on the basis of the information and documents provided to me by the applicant;
4. To the best of my knowledge, I have not commended any other action or proceeding
involving the same issue in any other LTFRB office;
5. To the best of my knowledge, no such other application, petition or pleading is pending
therein, and 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 there from to the honorable
board.

Applicant

SUBSCRIBED AND SWORN to before me this _________________ day of

__________________ at ______________________, Affiant exhibited to me his
_______________________ issued at _____________________ on ______________________.

Doc. No.: ___________________

Book No.: ____________________
Page No.: ____________________
Series of 2021.