Distribution of copies:

Original - CLUPPU/RCLUPPI
Duplicate - Accounting Division
Triplicate - Applicant
LUC FORM D
SERIES OF 2002

(To be filled-up CLUPPI/RCLUPPI)

Republic of the Philippines

DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation (CLUPPI)
Office (Central/RCLUPPI): _______________

BRIEFER
APPLICATION FOR LAND USE CONVERSION

Name of Landowner/s : _____________________________________________________________

Representative : _____________________________________________________________
Address : _____________________________________________________________
Location of Property/ies : _____________________________________________________________
Total Area (In Hectares) : _____________________________________________________________
Proposed Use : _____________________________________________________________
Date of Filing : _____________________________________________________________
Developer : _____________________________________________________________
Address : _____________________________________________________________
Number of Parcels : _____________________________________________________________

(Attached Description of Landholdings Per Sworn Application for Land Use Conversion)

Certifying
Agency Remarks Officer/ Date
Designation

HLURB

DA

DENR
Other Documents

(Use separate sheet if necessary and attach as an annex to this LUC Form)

Findings/Issues:
(State lacking requirements, clarifications to be made [i.e. applicant, government agencies])

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