Repl of the Pippin Office ofthe President Housing and Urban Development Coordinating Council HOUSING AND LAND USE REGULATORY BOARD MEMORANDUM CIRCULAR NO. (2. Series of 2005(_/2 January) TO ALL REGIONAL OFFICERS FROM THE COMMISSIONER AND CHIEF EXECUTIVE OFFICER SUBJECT REVISED APPLICATION FORM, REQUIREMENTS, EVALUATION REPORT AND LOCATIONAL CLEARANCE PRO-FORMA In response to the recent policy issuances and feedback from HLURB regional field offices, Memorandum Circular No. 03, dated 11 September 1986, entitled “Revised Application Form, Application Requirements Checklist, Evaluation Report and Decision Form for Applications for Locational Clearance/Certificate of Zoning Compliance” is hereby amended as attached. The revised pro-forma documents include: > Application Form for Locational Clearance (Annex A) > Application Requirements for Locational Clearance (Annex B) > Affidavit (Annex C) > Project Evaluation Report (Annex D) > Locational Clearance (Annex E) The abovementioned documents shall be used in processing locational clearance applications for cities and municipalities which have not assumed the function. The same however shall also be the suggested pro-forma documents in cases of queries from LGUs which have assumed the function of issuing locational clearances. For your proper guidelines and compliance ROMULO. one HLURB Bldg, Kalayaan Avenue comer Mayaman Street, Diliman, Quezon CityANNEX A a a . ».JUSING AND LAND USE REGULATOR 3OARD REGION APPLICATION FOR LOCATIONAL CLEARANCE. Application No. Date Issued Date of Receipt Amount Paid ‘P- PMO No/OR No. [ 1. NAME OF APPLICANT (Last First Middle) 2. NAME OF CORPORATION 3 ADDRESSITELEPHONE OF APPLICANT 4 ADDRESSITEL OF CORPORATION 5. NAME OF AUTHORIZED REPRESENTATIVE & ADDRESS/TEL OF AUTHORIZED REPRESENTATIVE T.PROJECT TYPE 8, PROJECT NATURE ~ [._] New Development [Others (specify) 9, PROJECT LOCATION 10. PROJECT AREA (in square meters) (No,, Street Bray. City/Municipalty, Province) Lot __ Building Improvement 11. RIGHT OVER LAND 12. PROJECT TENURE { ]Owner [1 Others (Specity) { }Permanent [__|leese {__ [Temporary 73. EXISTING LAND USE OF THE PROJECT SITE: [| ]Residential [Commercial [ Others [ ]Vacantldle [ Agicuitural (Speciy crop) [_Jinstitutional _[_] Industrial _ [_]Tenanted [ _] Not tenanted 14 PROJECT COST (in pesos, write in words and figures) — —— (P. ) 15. 1S THE PROJECT APPLIED FOR THE SUBJECT OF WRITTEN NOTICE(S) FROM THIS BOARD OR THE LOCAL GOVT. UNIT (LGU) TO PRESENT OR APPLY FOR LOCATIONAL CLEARANCE (LC)? {_ ] Yes. (Pls Indicate the following) T 1No Iscuing offioor Order in the nolice __ Dato of notice _ — _ — 16. 1S THE PROJECT APPLIED FOR THE SUBJECT OF RELATED ACTION(S) WITH OTHER OFFICES OF THE BOARD ‘ANDIOR LOCAL GOVERNMENT UNIT? 1 Yes (Please indicate the following) [No ‘Offige where similar action(s) was fled Date fled Actions taken 17. PREFERRED MODE OR RELEASE OF DECISION: [_]Pick-up _{_]By mail, addressed to {_]Applicant [__] Authorized Representative 18, SIGNATURE OF APPLICANT | 19. SIGNATURE OF AUTHORIZED REPRESENTATIVE | Republic ofthe Philippines) SS. SUBSCRIBED AND SWORN TO before me this ___ day of 20___ in the City/Municipalty of _ , province of Afiant exhibited hislher Community Tax Certificate No. issued at on NOTARY PUBLIC Doe. No. Page No. | Book No. | Series No.ANNEX B APPLICATIOM-SEQUIREMENTS FOR LOCATION“. CLEARANCE BASIC REQUIREMENTS (one copy per document) 4. Duly accomplished and notarized Application Form. 2. Any of the following requirements relative to right over land: a. Photocopy of the certificate of title, in case registered in the name of the applicant; b. Inthe absence of any existing certificate of title in the name of the applicant, submit: b.1) Certified true copy of the latest tax declaration b.2) Pro-forma affidavit (see attached form) to the effect that: ‘* the applicant is the owner of the property subject of the application; + the reasons why the property is not yet titled; * that the property is situated within alienable and disposable lands and outside lands reserved for the public domain; + that the property is free from liens and encumbrances of the property; * that the property is tenanted. ©. Incase the property is not registered in the name of the applicant, submit a photocopy of the ‘owner's certificate of title or in the absence of title, the tax declaration and pro-forma affidavit as described in item b. and any of the following: ** duly notarized deed of sale or deed of donation «contract of lease ‘* authorization to use land, whichever is applicable 3. VICINITY MAP showing the existing land uses within the minimum of 100 meters and 1-kilometer radius from the lot boundary of the project site for projects of local and national significance, respectively. 4. SITE DEVELOPMENT PLAN showing the project site lot area boundaries and proposed layout of improvements therein. 5. Environmental Compliance Certificate / Certificate of Non-Compliance (ECC/CNC) ADDITIONAL REQUIREMENTS (one copy per document) 1. For LGUs that have assumed HLURB devolved functions: Zoning certification issued by the HLURB regional officer indicating that the project site is within the area zoned as non-agricultural per approved/ratified CLUPs and ZOs. 2. For Manufacturing projects: DESCRIPTION OF INDUSTRY citing among others the following: 1.1. Types and volume of raw materialsichemicals used; 1.2. Products manufactured or stored; 1.3. Average production output/capacity per dayweek/month; 1.4, _ Industrial wastes and plans for pollution control; 1.5. Description of process flow or manufacturing processes; 1.6. Manpower Requirements 3. Bill of Materials and Cost of Equipment (where applicable) 4. For applications filed by authorized representative: ‘Swom Special Power Of Attomey for the representative to file/follow up application, and to claim decision on the application. 5. Other additional documents as may be needed for projects of national significance which require bi more exhaustive evaluation. /ANNEX C AFFIDAVIT I, of legal age, single/married, Filipino citizen, with postal address and residence at after being swom to in accordance with law, do hereby depose and state THAT: 4. 1am the owner of a parcel(s) of land located at with an area of square meters, covered by Tax Declaration No.(s) ; 2. The abovementioned property(ies) is/are the subject of an application for Locational Clearance for (Project Type) 3. The abovementioned property(ies) was/were acquired by way of (Slate whether by sale or inhertance, tc ) but has/have not been issued certificate(s) of title considering the following reasons: 4. To the best of my knowledge, the said property(ies) is/are situated within alienable and disposable lands and outside lands of the public domain and the same is/are now utilized for agricultural purposes, particularly for the cultivation of and is/are (indicate crops) [ ]tenanted [ ] not tenanted 5. Further, to the best of my knowledge, the abovementioned property(ies) is/are free from any alien ‘or encumbrance other than (indicate lens and encumbrances, any) 6. 1am executing this affidavit to attest to the veracity of the abovementioned facts and in compliance with the requirements of the Housing and Land Use Regulatory Board or Sangguniang Bayan/Panglunsod relative to the application for Locational Clearance for the abovementioned project Affiant further sayeth naught In witness whereof, | have set my hand this day of 20, at , Philippines. " Affiant SUBSCRIBED AND SWORN TO me this day of 2 affiant c exhibiting to me his/her Residence Certificate No. issued at on a —____— b / é Notary Public Doc. No. Page No. Book No, Series ofANNEX D oN PROJECT EVALUATION REPOF ‘A. APPLICANTS INFORMATION Name of Applicant (Last, First, Middle) Name of Corporation | Address/Telephione of Applicant ‘Address/Telephone of Corporation B. PROJECT INFORMATION Name/Type Classification : Location ‘Site Zoning Class Area (sq.m.): Right Over Land Area of Bidg. Others : _ C. SITE INSPECTION FINDINGS Dale of Inspection - Existing land uses within lot boundaries of project site Project Status as of Inspection Date Mere ea [ ] Proposed I} Completed t Agricultural L JOthers { 1 Operational [ 1% Completed [ ] Others (Specify) In case of agricultural Existing Land Uses Abutting Lot Boundaries of the | SPecify crops Project: Tenancy Status North (a) ‘South (b) [ ]Tenanted [_ ] Not Tenanted East (c) West (d) Existing land uses 400m R 500m R 100m R 500m R Residential 0) U1 Industrial 1 C1 Commercial ) U1 Agricultural [) tl Institutional Ct) C1 Others (Pls. Specify) {] C1 — D. SKETCH OF PROJECT LOCATION & SIGNIFICANT FINDINGS2 E. LEGAL BASES RECOMMENDED DECISION Legal Bases : [ ] CLUP/ZO approved by HLURB/SP per Res. # Series of (date) Findings and Evaluation of Facts: I ] Others (Specify law, Implementing Rules and Regulations or Guidelines) Recommended Decision F, ADDITIONAL CONDITIONS As may be necessary, restrictions may be imposed, e.g. setback, building height, compliance to specific requirements of other agencies and/or as provided for in local zoning ordinance. G. SIGNATORIES Prepared by: Noted by: Print Name and Sign/Designation Print Name and Sign/Designation Date Date G. REPORT ATTACHMENTS [_ J Location as inspected [ ] Others (Specify) ] Supplementary report /O ANNEX E mo LOCATIONAL CLEARANCE Application No. Decision No. Date of Receipt Date Issued Name of Applicant | Name of Corporation ‘Address/Telephone of Applicant | Address/Telephone of Corporation | Name/Type of Project Project Location | Right Over Land Land Area Building | Evaluation of Facts Decision CONDITIONS : [ ] Allconditions stipulated herein form part of this decision and are subject to monitoring. [ ] Non compliance therewith shall be a cause for cancellation or legal action. [ ] The applicable requirements of government agencies and applicable provisions of existing laws shall be complied with. I] No activity other than that applied for and granted shall be conducted within the project site { ] No major expansion, alteration and/or improvement shalll be introduced without prior clearance from this Office. [ ] _ This decision shall not be construed as a Certification of Ownership over the parcel(s) of land subject of this decision. [1 Any misinterpretation, false statement or allegation material to the issuance of this decision shall be sufficient cause for its revocation. { ] Additional conditions: [ ] Provision as to setback, yard requirements, bulk, easement, area, height and other restrictions shall strictly conform with the requirements of the National Building Code of the Philippines and other related laws. ft {1 This decision shall be considered automatically revoked if project is rey commenced within one (1) year from the date of issue of this decision/ / / t Regional OfficerRepublic ot se Pilipinas Ministry of tlursan Settlements HUMAN SETTLEMENTS REGULATORY COMMISSION HSRC NENORANDUK CLACULAR Series of 1986 ( ! Sephumbip ro : kegional Technical coordiaater pepatia ALL concerned 4“ : The Gomaissione: ond Chief Executive o = icc on existing systems and cations tor Locational the commission's putiged zomins Admi= Acreby revised as im view of stuaies, feta procedures relative co the processing vi spot Clearance and certiticate of zoning gorplisace 0} Central offices, aeqional tat chistsators, ene sucject for provided fer in the Zollowis, annex cs unis circulars sting and feedva ef zoning Compliance ANWEX Di Checklist of application jequirements including List of Projects of National Ji,uiticance and schedule of ny (Yor Locational yhe utilization of the abovelisted sents checklist Shall ve governed hy the followin, qae gvaiuation deport (Ane: 3) wuleh replaces tie site inspeepion report fore shsil at ciwes ve prepared prior ko the issuance of any decision on ex appileation wnether or not ite inspection vas coniu.te 2, he vecision on zeains sos iL He utilized for all actions on appiicaciouSsier loceisoual clearance/certi- cate of coming co: e FLis aay ofsdee of the Vv Goodwill ulin, 393 Bueno Avenue Extension, Makati, Metro Maia P.O. Box 3056 Molt tein Te. Now S6-96491 to 28Commission including its deputees, The type of decision to “be granted shall likewise be indicated below the title Deci- sion on Zoning. 5 3. As much as possible, all conditions which are to be provided ese nelasct ston] teat sLealiadtcstead ales face of the Beci- sion (front page), This circular takes effect immediately. Please be guided accordingly. Meteo MrouaANNEX A Of HSRC Memoranc ~ Citeular No. (AI Series oF ibe ~~ hen Application yo. HUMAN SETTLEMENTS RE ATORY COMMISSION Date of neceipt PMO No./OR Now SSS pate tssued | OFEIce and Address mount paid Po , APPLICATION FOR LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING COMPLIANCE I WANE OF APPLICANT(LOSt, First, Middle) |2. NAME OF CORPORATION = ADDRESS OF APPLICANT 5. ADDRESS OF CORPORATION |" WANE OF AUTHORIZED REPRESENTATIVE 5. ADDRESS OF AUTHORIZED REPRESENTATIVE | 7. PROJECT TYPE PROJECT NATURE FAiwew pevelopment /~Tothers (specify) TT improvement Toc PROJEGT LOCATION ——SSOSC~* fo Snort AKER (in Square weteray | (quaber, street, Barangay, city/Munici~ ———— ality, Province BUTLDING(S)/ IMPROVEMENTS -——— browicnr oer oe ee (Towner 7 others(specify) IT permanent TT Lessee TT temporary (specify years) EXISTING LAND USES OF PROJECT SITE: T-Twacant/1ate [PTresidential — /7industrial TTagricultursl (specify crop): TTinstitutional TJothers(specity) =~ T7eoamercial | Lyrenaated TT wot tenanted —FROTECT COSTTCAFTTALTEATION Cis pasos; WHITE In WOES and ETGUFES) [STIS THE PROJECT APPLIED FOR THE SUBJECT OF WRITTEN WOTICE(S) FROM THIS COMMI- SSION AND/OR LTS DEPUTIZED ZONING AJMINISTRATOR T0 THE EFFECT REQUIRING FOR SRESENTATION OF LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING COMPLIANCE (1C/ Czc) o& TO APPLY FOR Lc/czc? / Tres 7 TNo by GE yes, please answer the following: — 4 15.25 hane of ugne officer or Zoning Administrator who issued the notice(s): 5.d) pate(s) of notice(s) 715.) orders/requests indicated in the notice(s): hex is-TiE PROJECT APPLIED FOR THE SUBJECT OF SIMILAR APPLICATION(S) WITH OTHER T deen Pap THE COMMISSION AND/OR DEPUTIZED ZONING ADMINISTRATOR? J7ves S77 CEyes, please answer the followin HLS oeher Nene office(s) where similar application(s) was/were filed: 16.0) REE rere} BatiSa tay. takea by -OFFTES (ay wentroned Te TOay_ we TE OP EASE OF DECISIONS SOSCSC~—SsS—S—SY Pfpick-up Tay Mail, addressed to = PT applicant [7 authorized Representative \IS.- SIGNATURE OF APPLICANT TY. SIGNATURE OF AUTHORIZED REPRESENTA™| TIVE gepublic of the philippines). Js. | SmscniDED AND Gwenn qo before we this dey of 119 Am the ctty/ Municipality of , Province of ———— affTant exhibited wunkclpal ity Of (sraeace_GartInicate wo. —— a sk — ————— aos Page Noe hotany PUBLIC series oallt re ANNEX B of HLRB iemorandum Circular No. 12 __. Series of 1996 APPLICATION REQUIREMENTS FOR LOCATIONAL CLEARANCE/ CERTIFICATE OF ZONING COMPLIANCE 1. Basie Eesulrementia (one copies per documents) Duly accomplished and notarized APPLICATION FORM Any v= the following véquirements relative to RIGHT OVER LANI a. Photocopy of the certificate’of title, in case registere in the name of the applicant; b. In the abseace of any existing certificate of title in the name of the applicant, submit’b.1) Certified true copy of the iatest tax declaration and 6.2) pro-forms affildavit (see-attached form) to the effect that. - the applicant ia the owner of the property subject of the applicant; - the reasons why the property ie not yet titled; at the property is situated within aliensble and dis- posstie lands and outside landa reserve for the public demain; - that the property is free from liens and encumbrances; or stating the liens and encumbrances of the property; - that the property is/is not tenanted (in case the pro- perty is planted to rice and corn). In osse the property is not registered in the name of the applicant, submit duly notarized deed of sale cr deed of. donation, or contract of lease or .authorization to use iand, whichever is applicable plus the photocopy of the owner’s certificate of title or in the absence of title, the tax declaration and pro-forma affidavit as described in ivem b. hereof. sapence showing the existing land uses within the bed radius from the lot boundary of the project site. a. Tor progects vf local eignificance, the cover a minimum of 100 meters radius, and che map used inity should not be drawn to scale provided the relative distance of existing land uses to the projest site lct boundaries are indicated; b. For projects of national significance, the vicinity should cover a minimum of one (1) kilometer radius. and should be drawn to scale. 4. SITE DEVELOPMENT PLAN ehowing'the project site lot area boun- daries end dimensiona of proposed improvements w thin the pro- 7)ject alte; the plan neéd not be drawn to scale for projects of local significance. Il. Additions] Requirements (one copies per documents) i. For All PROJECTS to be situated Rice and/or Corn Lands: Tadorsenent /Recommendation from the Ministry of Agrarian c. For Menafacturing projects; DESCRIPCION OF INDUSTRY citing snong-others the following: 1 Types and volume of raw materials used; 2 Products manufactured or stored; 3 Average production output/capacity rer day/week/month 4 Industrial wastes and plans for pollution control 18 Deseripcion and flow or manufacturing processes. 3. For_applicetions filed by Authorized Representative: SWORN SPECIAL POWER OF ATTORNEY for the representative to file/follow up application, and claim decision to the application. NOWNN 4, Others additional requirements may be necessary for pro— Jecte or eveas governed by other HLRB Rules, Guidelines or Standards for in such other cases requiring a more ex- haustive evaluation. Submit such other additional requirements only upon WRIT- TEN REQUEST ae authorized by the Director of the Develop- trol Gffice and/or the commissioner-in-charge for oreement, in cases of application filed at Central ce and at the offices of central-reporting Deputized Zoning Adminiatration; or by the Regional Field Office and Officee of region-reporting Deputized Zoning Adminis. NATIONAL SIGNIFICANCE PER HLRB MEMORANDUM 1. Power generating plants 7. Large-scale piggery (25 heads 2. Airport /seaports or more} 3. Residential/cox ial/farmlot Large-scale poultry (10,000 industria! subdivision heade or more) 4. Memonial Pavks/cemeteries 6. Mining end quarrying projects 5. Dumping sites/incinerators 9. Government Center 6. Reclamation sites 10. Wood processing plents, e.8.- ll. High intensity industries NOTE: LEGAL RESEARCH FEE amounting to one (1)% of the filing fee impose but in no case lower then ten pesos shall be collected in addition to the filing fee.ANNEX C Of HSRC Memorandum a Ey net C A ARRIDAYIT L of Legal age, single/married, Pilipino citizen, WIth postal address and Tesidence at after being sworn to’in accordance with law, hereby depose and state the — following: . 1) That 1 am the owner of certain parcel(s) of land located at with an area of wumber, Steet, parangay, City/Mumicipality, province, square meters, covered by Tax Declaration No(s), 2) ‘that the abovementioned property(ies) is/are the subject of appli- cation for Locational clearance/certificate of zoning compliance for (state project type); + 3) that the abovementioned property(ies) was/were acquired by way of ‘(state whether by sale or Inheritance, ete.) 4) That the abovementioned property(ies) is/are not yet issued certi- ficate(s) of title considering the following reasons; 5) That to the best of my knowltdge, the abovementioned property(ies) is/are situated within alienable and disposable lands and outside Lands reserved for the public.domain; 6) That to the best of my knowledge, the abovementioned property(ies) is/are free from any lien or encumbrance other than ; (indicate Liens and enculibrances, If any) 7) por agricultural ands only: That the abovementioned property(ies) is/are utilized for agricultural purposes, particularly for the cultivation of (indicate crops) and said property(ies) is/ are] tenanted 77 aot tenanted; 8) ‘That 1 em executing this effidavit to attest to the veracity of the abovementioned facts thereby satisfying the requirements of the yuman settler ments Regulatory commission relative to the application for ,ocational clear~ fance/certificate of zoning compliance for the abovementioned project. affiant further says nothing. | CF Sa he Pnppines APEIANT epublic of ni Lippines Republic of the philippines). ¢_ SUBSCRIBED AND ‘SWORN TO before.me this éay of v__ Steiane exhibiting to me his/her pesideace certificate Nos issued at on * NOTARY PUBLIC Doc. Now. Page No. Book No. 5 series of.auwex b of HSKC Memoral » Giccular wo. (¢)_ series © EVALUATION REPORT 4 ‘A, APPLICANT AND PROJECT INFORMATION WANE OF APPCICANT(LOSt, FIFSE, MEGSTey | Z~ WANE OF CORPORATION [5c annRESS OF APPLICANT + RUDRESS OF CORPORATION =| oe |S. PROJECT TYPE SS AREATEN BGs) | 7 LOCATION (NO> »SE-y Bay-crey Lot: Municipality, province) BLDG’TOTHERS: Bs PROJECT: EVALUATION TSSPROJEGT LIFESPAN ['> PROJECT TUS PROJECT CLASSIFICATION Et vevaal sugure cance ee TT tenporsry Local. a CTR (specify yrs) 77 National + STTE ZONING CLASSIFICATION EXISTING TAND USES IN THE VICINITY, 7 RTGR, OVER TANT s (a) Radius covered from Lot bound ary of project sit oye Tart wes wre | C7 100 neters (local signiti- radius and corresponding per~ cance) centages: © ‘ C7 1+ Wwattl.” significance) 2 Ge LEGAL BASES FOR EVALUATION AND RECOMMENDED DECISION Aen GE an VLE OF PACTS 7 Ordinance Ro-__8-__approved per K! gnc nes. Now series of 19 ay behers (specity "law, implebentTag — ooo] f=" Yule, standard or guideline) f ; u 4 —p {DECISION RECONNENDED + Dy SHRE TNGPECTION FINDTGS (FiLl-up if sige vas inspected) I'7s-DATE OF INSPECTION [18. PROJECT StATUS_AS OF TR SPECTION DATE= | Fae proposed /—7 completed J 7, operational Ty ee eompleted 7 others NOTED BY? signature Name ' > pate REPORT ATTACHMENTS [7 vicinity nap as tuspected /°7 supplementary Report /77 others (specify)ANNEX E of HSRC peRc ‘dum circular Wo. CLD seriz of 1986 ouAi SETTLEMENTS REGULATORY COMMI. ON ——— OFFIee aad Aaaress DECISION ON ZONING pecision yo. Date of issue Application No. pate of expiratYon oF TOP* pate of Receipt APPLICANT WANE OF CORPORATION ‘ADDRESS ‘ADDRESS TPE OF PROJECT AREA AND LOCATION DECISION GROUNDS FOR DENTED APPLICATIONS CONDITIONS (7 M11 conditions stipulated herein form part of this decision and are subject to monitoring. : (77 won-conpliance therewith shall be a cause for cancellation ox legal action. (C7 the applicable requirements of government agencies and appli- Cable provisions of existing laws shall be complied with. (Two activity other than that applied for shall be conducted within —" the project site. /7T no major expansion, alteration and/or improvement shall be intro- A" Yuced without prior clearance from this office. /7T qhis decision shall not be construed as a certification of HSRC LT ito the ownership by the applicant of the parcel of land subject of this decision. IT any misrepresentation, false statements or allegations material eT tay the issuance of this decision shall be sufficient cause for its revocation, [77 additional conditions (77 provisions as to setbacks, yard requirenents, bulk, easement, trea, height and other restrictions shall strictly conform with the requirements of the National puilding code an¢ other related. laws. LJ this decision shall be considered automatically revoked if Tegject is not connenced within one (i) year from date of Yeoue of this decision. (77 wror projects Granted renporary use permit (Tup): Applicant Teceoi shall terwinate project activities on the date of perteation as above indicated; this office holds no assurance cee Sky Upplication for permit renewal may be granted. PMO Wol/OR NO+ pate rssued BY AUTHORITY OF THE COMMISSION: amount paid BO neers nS CC ne OF SCOT DR