CERTIFICATION

I, _____________, authorized representative of the landowner of the attached application for

conversion involving landholding/s with an area of ____________ square meters under the
following TCTs, to wit:

AREA PER AREA

LOT
LANDOWNER LOCATION TCT NO. TITLE APPLIED FOR
NO.
(sq.m.) CONVERSION
Brgy. _____, ______, TCT NO. Lot
1 __________________ ________ ___________
Batangas _______ ______

located at Barangay ________, _________, Batangas, do hereby certify that:

1. All supporting documents are true and correct;

2. All certifications issued by the Department of Environment and Natural Resources

(DENR), National Irrigation Administration (NIA), and all other certifications issued/
included and made part of this Land Use Conversion (LUC) folder are properly verified
and authenticated as to the truthfulness and correctness of all information contained
therein.

__________________
Authorized Representative
_____________________
Date Signed