Republic of the Philippines

BARANGAY MAPULANG LUPA

Valenzuela City
OFFICE OF THE PUNONG BARANGAY
APPLICATION FOR BARANGAY (ELECTRICAL COMPANY) CLEARANCE

DATE: _______________________

( ) NEW ( ) ADDITIONAL ( ) OTHERS : ______________________________

NAME OF APPLICANT / REPRESENTATIVE: _______________________________
ADDRESS : __________________________________________________________
POSITION : __________________________________________________________
NAME OF BUSINESS : ___________________________________________________
NAME OF OWNER: ______________________________________________________
NAME OF PROJECT: _____________________________________________________
LOCATION: ____________________________________________________________
TEL. NO.OFFICE : _______________________ RESIDENCE : ___________________
SIMPLE SKETCH OF LOCATION: (AT THE BACK)
ADDITIONAL REQUIREMENTS
1. Copy of Declaration of Real Property Tax (Xerox Copy)
2. Copy of Certificate of Title (Xerox Copy)

_____________________________
SIGNATURE OF APPLICANT
REMARKS:
( ) APPROVED CTC NO. : ____________________
ISSUED AT: __________________
( ) DISAPPROVED, ISSUED ON:__________________
REASON: _________________________
_______________________________________ CLEARANCE FEE: ____________
_______________________________________ O.R. NO : _____________________
DATE : _____________________
INSPECTED BY: NOTED BY:

__________________________________ ______________________________
Brgy. Official / Councilman Punong Barangay

Prepared by : YOLLY D.M

 Republic of the Philippines
BARANGAY MAPULANG LUPA
Valenzuela City
OFFICE OF THE PUNONG BARANGAY
APPLICATION FOR BARANGAY (ELECTRICAL RESIDENTIAL) CLEARANCE

DATE: _______________________

( ) NEW ( ) ADDITIONAL ( ) OTHERS : ______________________________

NAME OF APPLICANT / REPRESENTATIVE: _______________________________
ADDRESS : __________________________________________________________
NAME OF OWNER: ______________________________________________________
NAME OF PROJECT: _____________________________________________________
LOCATION: ____________________________________________________________
TEL. NO.OFFICE : _______________________ RESIDENCE : ___________________
SIMPLE SKETCH OF LOCATION: (AT THE BACK)
ADDITIONAL REQUIREMENTS
1. Copy of Declaration of Real Property Tax (Xerox Copy)
2. Copy of Certificate of Title (Xerox Copy)

_____________________________
SIGNATURE OF APPLICANT
REMARKS:
( ) APPROVED CTC NO. : ____________________
ISSUED AT: __________________
( ) DISAPPROVED, ISSUED ON:__________________
REASON: _________________________
_______________________________________ CLEARANCE FEE: ____________
_______________________________________ O.R. NO : _____________________
DATE : _____________________
INSPECTED BY: NOTED BY:

__________________________________ ______________________________
Brgy. Official / Councilman Punong Barangay

Prepared by :