Republic of the Philippines

Province of Leyte
MUNICIPALITY OF TUNGA
Barangay San Antonio, Tunga, Leyte
-oOo-
Office of the Sangguniang Bayan

LUDP FORM NO.1

Series of 2021
(To be filled-up by the applicant)

SWORN DECLARATION OF APPLICATION FOR DEVELOPMENT PERMIT

HON. REINBERT C. COSTELO

Municipal Vice-Mayor, and
THE HONORABLE MEMBERS
Sangguniang Bayan
Municipality of Tunga
Province of Leyte

Gentlemen:

Pursuant to Municipal Ordinance No. 05, series of 2021, I hereby apply for the Development Permit of the
landholding/s as reclassified from [ ] agricultural / [ ] non-agricultural to
_________________________________________________________________________________________
(Please indicate the specific proposed development, ex. commercial - gasoline station)

I. APPLICANT’S PERSONAL CIRCUMSTANCES

A. Landowner
(As indicated in the proof of ownership presented)

Name : ___________________________________________________
Address : ___________________________________________________
___________________________________________________
Postal Address : ___________________________________________________
___________________________________________________
Contact Nos. : ___________________________________________________

B. Representative
(If the applicant is other than the landowner)

Name : ___________________________________________________
Address : ___________________________________________________
___________________________________________________
Postal Address : ___________________________________________________
___________________________________________________
Contact Nos. : ___________________________________________________

Nature of Authority (to be attached):

[ ] SPA [ ] Board Resolution

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 Republic of the Philippines
Province of Leyte
MUNICIPALITY OF TUNGA
Barangay San Antonio, Tunga, Leyte
-oOo-
Office of the Sangguniang Bayan

II. DESCRIPTION OF LANDHOLDING/S

A. Land Title/s and Area Applied (Please use additional sheet, if necessary)

Area Applied
Area per
OCT/TCT/TD for Land Use
Registered Owner Lot No. Title
No. Reclassification
(hectare)
(hectare)
1.
2.
3.
4.
5.
TOTAL

B. Location : ______________________________________________________________
(Barangay, Municipality, Province)

C. The area reclassified has premature development/activities

[ ] Yes [ ] No

D. Existing Land Use/s

Land Use
Area
OCT / TCT / TD No. (Specify crops planted, ex. rice, corn, coconut,
(hectare)
sugarcane, etc.)
1.
2.
3.
4.
5.

E. Surrounding Land Use/s: ________________________________________________________

________________________________________________________

F. Approximate Distance (in km.) to any of the following:

National Highway ______ Municipal Hall ______

Provincial Road ______ Barangay Hall ______
Municipal Road ______ Public Market ______
Barangay Road ______ Public School ______

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 Republic of the Philippines
Province of Leyte
MUNICIPALITY OF TUNGA
Barangay San Antonio, Tunga, Leyte
-oOo-
Office of the Sangguniang Bayan

III. SWORN STATEMENT

I hereby certify that all information above-stated are true and correct to the best of my knowledge.
It is understood that any misrepresentation on my part will be sufficient cause for denial of this
application or cancellation or withdrawal of development permit approval and blacklisting of my person
or my representative from any dealings with the Sannguniang Bayan of Tunga, Leyte.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

__________________,
20___, at _________________________________________________________________________.

____________________________________
Signature above printed name of
Landowner / Representative

Republic of the Philippines )

_______________________ ) S.S.

SUBSCRIBED AND SWORN to before me this _____ day of __________________ 20___ in the municipality of
____________________, province of _______________________. Landowner/Representative of exhibited to
me his/her Passport No. / Community Tax Certificate No. / Tax Identification No. / Type and Valid I.D. No.
________________________________ issued at _____________________ on _______________________
at _______________________________________________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of ________

NOTARY PUBLIC

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