Republic of the Philippines

DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT

Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

RE: ____________________________________
_____________________________________
(Name of Project and its Location
as indicated in the submitted Sworn Registration Statement)

_________________
(Date)

The Regional Director,

Pursuant to pertinent laws and the implementing rules and regulations of this Board, I am hereby
applying for a CERTIFICATE OF REGISTRATION (CR) and LICENSE TO SELL (LS) for the
above mentioned project.

Please consider the attached documents listed below with check or cross (“/” or “x”) and numbered
consecutively to support the application for CR/LS:

( ) Sworn registration statement

( ) Certified true copy of title(s)
( ) Approved verified survey return
( ) Duly audited balance sheet & financial statement
( ) Articles of Incorporation, by- laws, and latest annual corporate report to SEC
( ) Copy of brochure, circular or prospectus for advertisement
( ) Sample copy of Contract to Sell
( ) Affidavit signifying willingness to change name
( ) Affidavit as to provision of PD 957/BP 220/ EO 648(Form R1)
( ) Affidavit of non-encumbrances (Form 1120)
( ) Fact Sheet
( ) Environmental Compliance Certificate (ECC)/EGAR Attached
( ) Certificate of Exemption from the ECC
( ) Permit/Certification from local power source
( ) Permit/Certification from water district
( ) Sangguniang Resolution or Ordinance approving the subdivision plan
( ) Preliminary Approval & Locational Clearance approved by LGU concern
( ) Approved subdivision (engineering) plans by the LGU concern
( ) Development Permit
( ) Project Study
( ) Permit to operate deep well and a water resistivity test
( ) Bill of materials & Cost estimates
( ) DAR Clearance (if zoned agricultural)
( ) Program of development
( ) Original BIR Zonal Value Certification
( ) Geotagging of Compliance Project
( ) Others:
( ) PHILVOCS Certification
( ) Civil Aviation Authority of the Philippines (CAAP) Certification (if applicable)
For Condominium Projects:
[ ] Master Deeds with Declaration of Registration and Declaration of Restrictions evidences by the
proper annotation thereof in the title(s) of the property and the certified true copy of such
title(s) from the Register of Deeds.
[ ] Building Permit
[ ] Affidavit of Undertaking to Submit Condominium Certificate of Title [PRLD.CCT.004-B.00]
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

For Subdivision Projects:

[ ] Verified Survey Returns (two (2) copies)
[ ] Sangguniang Resolution/Ordinance granting of Development Permit/Subdivision Development
Plan
[ ] Certified True Copy of resolution conferring authority to the mayor or other local government
official to issue Development Permit
[ ] Proof of Compliance to Sec. 18 of R.A. No. 7279 as amended by R.A. No. 10884
[ ] One (1) set of Subdivision Development Plans
[ ] Engineering Plans and Specifications approved by LGU
[ ] Affidavit of Undertaking to submit Transfer Certificate of Title (parks, playground, community
facilities and other open spaces) [PRLD 0004-A.02]

In this connection, I attest to the fact that: (1) The number identifying the documents listed above
under perspective applications corresponds to each of the attached documents; (2) Duplicate copies are
the authentic and faithful reproduction of the original documents; and, (3) Documents conforms strictly
to the official checklist of requirements and the detailed description thereof.

I understand that additional requisites, including but not limited to subdivision approval and other
pertinent documents of the compliance project per R.A. 7279 (20% socialized housing under Section
18), if covered, the performance bond, and the balance of the processing fee or LS, may be required
only through a written notice signed by an authorized official and that, further action on subject
applications may be withheld if there is an unfavorable decision (final and executor) in case before this
Board or an order in connection with a violation against the undersigned applicant which has not been
complied with.

I can be reached at:

Address :
Telephone No. /CP No. :

Or through my representative:

Address :
Telephone No. /CP No. :

Very truly yours,

(Printed Name and Signature)

(Designation/Position)

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant
exhibiting to me his/her Residence Certificate No. ______ issued at _______________________ on
__________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

REGISTRATION STATEMENT
(SINGLE PROPRIETORSHIP)

I, __________________________, Filipino, of legal age, single/married to ________________________, with

residence address at _______________________________, after being sworn to in accordance with the law do
hereby depose and state the following:

1. That I am engaged in the business of _____________________________________________________with

capitalization of ______________________________________________________________.

2. That I am the owner of certain parcel(s) of land situated at

_____________________________________________________ covered by TCT No(s).
____________________________________________________ comprising an aggregate area of
_____________________________________________ sq. m.

3. That I am developing said parcel(s) of land into a __________________________________________

____________________________ to be hereinafter called ___________________________________.
(Classification of Project) (Name of Project)

4. As the owner, and _________________________________________________, as developer of the project,

(Name of Developer)
I undertake to established and develop said project in accordance with the plans as approved by
the___________________________________________________________________________;
(Approving Institution)

5. 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)

6. That my authorized broker/s shall be

_______________________________________________________________________________
______________________________________________________.

7. 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, improvements, infrastructures and similar
forms of development hereon.

____________________________________ __________________________________
Date Place

__________________________________
Affiant

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant exhibiting to
me _________________issued in _____________________________on __________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

DECLARATION OF UDHA COMPLIANCE

(Main Subdivision Project)

A. MAIN SUBDIVISION PROJECT:

1. Name of Project _______________________________________________

2. Location _______________________________________________
3. Owner/Developer _______________________________________________
4. Total Project Area or _______________________________________________
Total Project Cost _______________________________________________

B. COMPLIANCE PROJECT :

B.1 Socialized Housing Projects or Facilities, Centers and Basic Amenities

a. Nature _______________________________________________
b. Name of Project _______________________________________________
c. Location _______________________________________________
d. Owner/Developer _______________________________________________
e. CR or CRLS No. _______________________________________________
f. Total Project Area or
Total Project Cost _______________________________________________
g. Allotted Block _______________________________________________
and lot or unit nos. _______________________________________________
h. Equivalent Area or Cost _______________________________________________

(and/or)

B.2 Instruments, Bonds, Provision of Land and Asset-Backed Securities

a. Nature of Participation _______________________________________________

Contribution, Provision _______________________________________________
Purchase or Subscription _______________________________________________
b. Certificate Number(s) _______________________________________________
and Official Receipt Nos. _______________________________________________
c. Total Amount/Cost _______________________________________________

_____________________________ ____________________
(Signature Over Printed Name) Date
Owner/Developer
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

DECLARATION OF UDHA COMPLIANCE

(Compliance Project)

I. COMPLIANCE PROJECT:

1. Name of Project ______________________________________________

2. Location ______________________________________________
3. Owner/Developer ______________________________________________
4. Total Project Area or Cost ______________________________________________

II. MAIN SUBDIVISION PROJECT

1. Name of Project ______________________________________________

2. Location ______________________________________________
3. Owner/Developer ______________________________________________
4. Total Project Area or Cost ______________________________________________

III. FUTURE OR SUBSEQUENT UTILIZATION

A. FUTURE UTILIZATION _________YES ___________ NO

B. CURRENT AND SUBSEQUENT
UTILIZATION _________ YES ___________ NO

1. Current allotted block _________________________________________

And lot or unit nos. _________________________________________
_________________________________________
_________________________________________
2. Equivalent Area or Cost _________________________________________

3. Remaining number of blocks_________________________________________

And lots or units, and _________________________________________
Equivalent remaining area or cost _____________________________________

_____________________________ ____________________
(Signature Over Printed Name) Date
Owner/Developer
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

REGISTRATION STATEMENT
(CORPORATION)

I, _________________________________, Filipino, of legal age, single/married, with postal address

and residence at ____________________________________________________________________________,
after being sworn to in accordance with the law, do hereby depose and state the following:

1. That I am the _________________________________ of ________________________________________

(Position) (Name of Corporation)
______________________________with office address at ______________________________________
__________________________________________;

2. That the names and addresses of the directors, officer of _______________________________________are

as follows: (Name of Corporation)

________________________________ ______________________________
________________________________ ______________________________
________________________________ ______________________________
________________________________ ______________________________

3. That the general character of the business being conducted by _____________________________________

____________________________ is ______________________________________________________
with capitalization of _____________________________________ (P _____________________________)
broken down as follows:

Authorized _________________________________________ (P __________________);

Subscribed _________________________________________ (P __________________); and
Paid up ____________________________________________ (P __________________).

4. a) That said Corporation is both the owner and developer of certain parcels of land hereinafter
called __________________________________________________________________________ situated
at ____________________________________________________________________ and covered by
TCT’s No. (s) _______________________________________ comprising an aggregate area
of _________________________ sq.m.;

or

b) That said Corporation is the developer of certain parcel/s of land hereinafter

called _______________________________________ situated at_________________________________
and covered by TCT’s No. (s) _________________________________________ comprising an aggregate
area of _____________________sq.m.;
(Fill-in either a or b whichever is applicable)

5. 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)

6. That our authorized broker/s shall be _________________________________________________________

7. In our capacity as owner and/or developer, we bind ourselves to comply with all the rules and regulations
pertaining to this project and shall be held responsible for all the facilities, improvements, infrastructures
and similar forms of development thereon.
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

____________________________________ __________________________________
Date Place

__________________________________
Affiant

CONFORMITY:

________________________
OWNER
(If # 4b above applies)

SUBSCRIBED AND SWORN to before to me in this ______ day of __________ 2022, affiant exhibiting to
me _________________issued in _____________________________on __________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

FORM No. 1120

Republic of the Philippines )
Municipality of ___________) s. s.
Province of ______________)

AFFIDAVIT OF NON- ENCUMBRANCE

I, ______________________, Filipino, of legal age, single/married to ____________________________

_______________, with postal address at ________________________________________________________
after being sworn to in accordance with the law hereby depose and state the following:

1. That I am the _______________________________ of _____________________________________,

(State Position) (Name of Corporation)
registered owner of certain parcel(s) of land located at ______________________________________________
covered by Original Certificate of Title/Transfer Certificate of Title No. (s) _____________________________

2. That the above-mentioned property/ies is/are the subject of application for Registration and License to
Sell for the proposed _______________________________________________________ now pending with the
(Project Name)
Department of Human Settlements and Urban Development (DHSUD);

3. That the best of my knowledge, said property/ies is/are free from liens and encumbrances;

4. That in the event said property/ies shall be mortgaged to any person, natural or judicial, I hereby
undertake to notify and secure the approval of the Department of Human Settlements and Urban Development
(DSHUD) prior to such mortgage;

5. That I am executing this affidavit to attest to the veracity of the above-mentioned facts thereby
satisfying the requirements of the Department of Human Settlements and Urban Development (DHSUD)
relative to my application for Registration and License to Sell for the above-mentioned project.

Affiant further says nothing.

____________________________________ __________________________________
Date Place

__________________________________
Affiant

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant exhibiting to me
his/her Residence Certificate No. ______ issued at _______________________ on
__________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

Form No. 1253

Republic of the Philippines )

Municipality of ____________) s. s.
Province of _______________)

AFFIDAVIT OF WILLINGNESS TO CHANGE NAME

I, _______________________, Filipino, of legal age, single/married to __________________________

_____________________ with postal address at ___________________________________________________

after being sworn to in accordance with the law hereby depose and states the following:

1. That I am the ___________________ of ________________________________________________

(State Position) (Name of Corporation)
owner/developer of ____________________________ located at ____________________________________;
(Name of Project)

2. That we have a pending application for Registration and License to Sell for above-mentioned project:

3. That to the best of my knowledge, there is no other project under such name under Presidential
Decree No. 957 and Executive Order No. 648;

4. That in the event that a project does exist, located in the same province as our project and is registered
with the Department of Human Settlements and Urban Development (DSHUD) or with the National Housing
Authority (NHA) under a name similar to our proposed name, we are willing to recognize its prior right over
and above our application;

5. That I am executing this affidavit to signify our willingness to change the name of our proposed
project to another name so as not to effect the vested rights and/or interests of the previous registered project.

Affiant further says nothing.

____________________________________ __________________________________
Date Place

__________________________________
Affiant

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant exhibiting to me
his/her Residence Certificate No. ______ issued at _______________________ on
__________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

Form No. RI
Republic of the Philippines )
Municipality of ___________) s. s.
Province of ______________)

AFFIDAVIT

I, ____________________________________, Filipino, of legal age, widow, with postal

address at _____________________________ after being sworn to in accordance with the law hereby
depose and state the following:

1. That I am the _______________________________ located at _______________________

______________________________ properly authorized to issue this affidavit for and in
behalf of said company.

2. That our company has a pending application for Registration and License to sell for the
above- mentioned project.

3. I hereby manifest and guarantee before this Board that in conducting its sales transaction
with the buying public it shall include/incorporate in its Contract to Sell form section
17,18,23, to 26 and 30 of PD 957/BP 220 and section 21,30 and 31 of its implementing
standards, rules and regulations, implementing subdivisions and Art. IV Section c of EO
648, Rules and Regulations for Memorial Parks/Cemeteries:

4. That I am executing this affidavit to attest to the veracity of the above- mentioned facts
thereby, satisfying the requirements of the Department and Human Settlements and Urban
Development (DHSUD) relative to my application for the registration and license to sell for
the above-mentioned project.

Affiant further says nothing.

____________________________________ __________________________________
Date Place

__________________________________
Affiant

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant exhibiting to me
his/her Residence Certificate No. ______ issued at _______________________ on
__________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

HLURB MC No. 04 S 1992

Annex H
Republic of the Philippines )
Municipality of __________) s. s.
Province of _____________)

AFFIDAVIT TO SUBMIT INDIVIDUAL TITLES

I, ________________________, Filipino, of legal age, widow, with postal address at

___________________________________ after being sworn to in accordance with the law hereby
depose and state the following:

1. That I am duly authorized for the purpose of this undertaking:

2. That I am the owner of _______________________ located at ________________________

_____________________________which is the subject of an application for the License to
Sell before the Department and Human Settlements and Urban Development (DSHUD).

3. That I fully understand the legal obligations of my company and guarantee and ensure the
delivery of individual titles to the lots/units purchased by the buyers as well as the
preservation and maintenance of areas declared as open space common areas for such
purpose.

4. That for reasons not attributable to our negligence or intentional malfeasance, and which are
beyond our control, the issuance of such separate titles and inscription of the required
annotation will take time.

5. That I hereby warrant that there is no legal reason or justifiable cause why said titles could be
issued in the normal course of business.

6. That I undertake to submit to this office within fifteen (15) calendar days from release of the
license to sell for the project proof of filling of proper and complete request or application
with the concerned register of deeds for the issuance of individual TCT’s or OCT for all
saleable lots or units and that if deemed necessary and upon demand by Department of
Human Settlements and Urban Development (DHSUD), copies of said title shall be
submitted.

7. That I undertake to submit certified true copy of titles for all the common area, each of
which shall specify the particular purpose for which the lots shall be used (parks &
playground, community facilities, etc.) no later than ______ days counted from release of
the license to sell.

8. That in the case of non- compliance herewith, HLURB may suspend our license to sell or
consider the same revoked, in addition, it may impose penalties for selling without any
license, and:

9. That I bind myself jointly and severally with the company in ensuring with the foregoing.
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

Affiant further says nothing.

____________________________________ __________________________________
Date Place

__________________________________
Affiant

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant exhibiting to me
his/her Residence Certificate No. ______ issued at _______________________ on
__________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

Fact Sheet and Ocular Inspection/Project Evaluation Report Form

PROJECT NAME : PURPOSE OF THIS REPORT :

LOCATION : TOTAL SALEABLE LOTS/UNITS :
OWNER : NO. OF LOTS/UNITS FULLY PAID :
ADDRESS : NO. OF LOTS/UNITS NOT FULLY PAID :
DEVELOPER : DATE OF DEV'T. STARTED :
ADDRESS : DATE PERMIT ISSUED :
LAND AREA : ISSUED BY :
PROJECT TYPE : DATE OF LICENSE ISSUED :
DATE OF INSPECTION : ISSUED BY :
CONDUCTED BY : DATE REGISTERED :
ISSUED BY :

QUANTITY TOTAL % COST REMAINING

ITEM DESCRIPTION PER UNIT UNIT COST OF OF DEV'T. REMARKS

PER
ITEM COST ITEM ACC. ACC. COST

MOBILIZATION/DEMO.
A. SITE PREPARATION
1. Clearing and
Grubbing
2. Cut & Fill
3. Excavation
B. ROADWORKS
1. Road Tracing
4. Sub Base Preparation
5. Sub-Base Course
6. Base Course
6. Concrete Pavement
7. Curb & Gutter
8. Sidewalk
C. DRAINAGE SYSTEM
1.Excavation/Backfilling
2. Compaction
3. RCP
4. Catch basin/Manhole
5. Box Culvert
D. WATER SYSTEM
1. Deep Well & Access
2. Water Tank &
Access.
3. Gate Valve
E. POWER SYSTEM
G. SURVEY WORKS
H. OTHERS
1. Parking Area
2. Basketball Court
3. Gate
4. Housing Components
TOTAL
 Republic of the Philippines
DEPARTMENT OF HUMAN SETTLEMENTS AND URBAN DEVELOPMENT
Kagawaran ng Pananahanang Pantao at Pagpapaunlad ng Kalunsuran
Regional Office 02
3rd Flr. PuR Seinte Bldg., Maharlika Highway, Tanza, Tuguegarao City, Cagayan
Email Address: region2@dhsud.gov.ph

Additional Information:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

VERIFICATION:

I, _____________________ of legal age , after having duly sworn, depose and say that I have read and accomplished this
form and the content thereof are true and correct.

_______________________
Project Engineer

SUBSCRIBED AND SWORN to before to me in this ______ day of ________ 2022, affiant exhibiting to me his/her
Residence Certificate No. ______ issued at _______________________ on __________________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________