February 6, 1998
DAR MEMORANDUM CIRCULAR NO. 03-98
TO : All Regional Directors, RCLUPPIs, Central Office CLUPPI 1 and 2, and All Others Concerned
FROM : The DAR Secretary
SUBJECT : Internal Guidelines for the Processing of Land Use Conversion Applications Under Administrative Order No. 7, Series of 1997:
"Omnibus Rules and Procedures Governing Conversion of Agricultural Lands to Non-Agricultural Uses," and its Amendments
A. Filing of Application
1. Applicant can secure one complete set of the Land Use Conversion Application/Certification forms (LUC Form Nos. 1 to 7 of A.O. 7 and LUC Checklist) from any of the following DAR offices at the cost of P50.00 per set: CAcIES
a. DAR Central Office — Center of Land Use Policy and Planning Implementation (CLUPPI)
b. Regional Agrarian Reform Office — RCLUPPI
The CLUPPI shall be responsible for the centralized printing of the complete set of application/certification forms and shall provide copies of the form to the different RCLUPPIs. The CLUPPI shall assign control number of the application/certification form for inventory purposes.
2. Accomplished and completed application forms and documentary Requirements must be submitted in five (5) sets (one set of original copy and four (4) sets of photocopy) with the Central Office CLUPPI or the Regional CLUPPI depending on which office has the corresponding jurisdiction.
B. Receiving the Application
1. All applications covering a total area of more than five (5) hectares shall receive applications for landholdings with an aggregate area five (5) hectares and below on a project basis.
For the purpose of determining the aggregate area involved, the area of the applications, regardless of the number of land use conversion applications or folders shall mean the total area of all applications involving:
a. Properties owned by the same person/s or entity or the owners of which are represented by the same person or entity; and
b. Properties located in the same barangay or adjacent barangays within the same Municipality/ies.
In cases where the subject matter of the application is adjacent to areas where the DAR has previously issued conversion orders the test above on the determination of aggregate areas shall be applied for purposes of determining the approving authority.
2. The CLUPPI/RCLUPPI shall designate a receiving officer, who shall:
a. Receive the application (in 5 sets and immediately review the completeness of the application and accomplish the checklist (LUC) Form A); and,
b. Return the application if incomplete/insufficient or give the application a copy of LUC Form A indicating the lacking requirements.
3. The reviewing technical staff shall assist the receiving officer in reviewing the application and accomplishing LUC Form A All required certifications, e.i., HLRB, DA, NIA, and DENR, as well as the SPA, should be original copies.
C. Assessment of Land Use Conversion (LUC) Application Filing Fee
1. If application is complete and insufficient, the reviewing technical staff shall issue an assessment of LUC application filing fee (LUC Form B) to the applicant, through the receiving officer.
The LUC application filing fees shall be as follows:
Applications : Fixed Fee : Variable Fee
Filed with the P1,000.00 : None
Regional Offices
of the DAR or
the Regional
CLUPPI (5
has. or below
Filed with P2,000.00 : Additional P10,000.00
CLUPPI for areas in Mindanao
P2,000.00 : Additional P7,000.00
for areas in Visayas
P2,000.00 : Additional P4,000.00
for areas in Luzon
2. Upon issuance of the approved assessment of LUC application filing fee, the applicant shall be advised by the receiving officer to proceed to the Accounting Division for the issuance of the Order of Payment before paying to the Cashier.
3. The amount paid, number and date of Official Receipt (OR) must be written by the CLUPPI/RCLUPPI receiving officer on the application form (LUC Form No. 1). Only those applications with OR Number shall be marked officially received and will be processed accordingly. The receiving officer shall also write the application number on LUC Form No. 1 for applications officially received, for control purposes.
D. Posting
1. Upon receipt of the OR of payment from the applicant, the
a. CLUPPI/RCLUPPI shall prepare the notice of Land Use Conversion Application (LUC Form D) and memorandum to the MARO (LUC Form No. C) advising him to post the Notice and transmit both Notice and the Memorandum to the MARO, by express mail, copy furnished the PARO.
Aside from the express mail, applicant may be allowed to hand-carry a copy of the accomplished Notice of Land Use Conversion Application (LUC Form D) and Memo to the MARO.
2. Upon receipt of the accomplished Notice of Land Use Conversion Application (LUC Form D) by express mail or thru the applicant, the MARO shall post LUC Form D in two conspicuous places in the municipality for a period of 15 calendar days, and accomplish the Certification on Posting of Notice of Land Use Conversion Application (LUC Form E), and then send the same to the CLUPPI/RCLUPPI by express mail. Aside from express mail, the applicant may again be allowed to hand carry a copy of the Certification and submit the same to the CLUPPI/RCLUPPI.
E. Evaluation
1. Simultaneous with the posting of Notice of Land Use Conversion Application, the CLUPPI/RCLUPPI technical staff shall evaluate the application as to completeness, consistency and sufficiency of the documents, and accomplish the Evaluation Sheet (LUC Form F).
2. The CLUPPI/RCLUPPI shall immediately inform the applicant of any lacking requirements and/or issues that have to be clarified (including inconsistency/insufficiency of information in the documents).
3. On titled lands being applied for conversion encumbrances, the applicant shall be required concurrence from the mortgagee.
F. Conduct of Field Investigation/Ocular Inspection
1. Within five (5) working days from the date of completion of the posting requirement, the CLUPPI Executive Director/RCLUPPI Chairman shall designate a member/s of the CLUPPI/RCLUPPI together with a member/s of the Secretariat, to conduct a field investigation and dialogue with the applicants and the affected farmer-beneficiaries, to ascertain the information necessary for the in-depth evaluation of the application. A briefer on the results of the evaluation of the LUCF shall serve as the reference material of the Team in the conduct of the field investigation.
2. Prior to the conduct of ocular inspection, CLUPPI/RCLUPPI shall send a radio message (LUC Form G) requesting the PARO to advise the MARO to accompany the CLUPPI/RCLUPPI investigation team. The CLUPPI/RCLUPPI shall also inform the applicant of the ocular inspection.
3. The CLUPPI/RCLUPPI Investigation Team shall proceed to the MARO office before proceeding to the site to be inspected.
4. The MARO shall inform the tenants, if any, to be at the site during the ocular inspection.
5. Immediately after the field inspection, the MARO shall issue the following certifications:
a. Certification on Conduct of Field Investigation (LUC Form H);
b. Certification on Tenancy/Non-Tenancy and CARP Coverage and Non-Coverage (LUC Form I); and
c. Certification on Completion of Posting of Notice of Land Use Conversion Application With Protest/Without Protest (LUC Form J). ESTcIA
G. Field Investigation Report
1. CLUPPI/RCLUPPI Investigation Team shall prepare Field Investigation and Verification Report (LUC Form K) within two (2) working days from the date of inspection and transmit the same to the Chairperson or Executive Director of the CLUPPI/RCLUPPI through the Head of the CLUPPI/RCLUPPI Secretariat.
H. Approval/Disapproval
1. Within ten (10) working days from submission of the investigation Report, the CLUPPI/RCLUPPI shall deliberate on the application and recommend the appropriate action on the same.
2. Within ten (10) working days from the date of deliberation, the CLUPPI/RCLUPPI shall prepare the Draft Order of Approval or the Order of Denial, with the corresponding control number and transmit the same to the concerned approving authorities, as follows:
a. DAR Regional Director, for application covering five (5) hectares and below.
b. Undersecretary designated by the Secretary, application in excess of 5 hectares up to 50 hectares.
c. Secretary, for application above 50 hectares.
3. Within ten (10) working days from the submission of the Recommendations, the approving authority shall issue action on the application.
I. Releasing and Transmittal of Signed Order
1. The Order of Approval/Denial, as well as the Land Use Conversion Folder (LUCF), shall be forwarded to the Records Division which will distribute copies of the Order to the concerned parties and keep custody of the LUCFs.
2. The Records Division of the DAR Central Office shall give one copy of the Order to the CLUPPI as well as one copy to the RCLUPPI and concerned PARO/MARO.
3. The Records Division of the Regional Office shall give one copy of the Order to RCLUPPI and concerned PARO/MARO. It shall also give two copies of the Order, together with one copy of the LUCF, to the DAR Central Office Records Division, thru the CLUPPI. The CLUPPI shall retain copy of the Order for its monitoring purposes and forward the other copy of the Order and the LUCF to the DAR Central Office Records Division.
4. The respective Records Division shall safekeep the original copy of the LUCF.
Diliman, Quezon City February 6, 1998
(SGD.) ERNESTO D. GARILAO
Secretary
LUC Checklist
Series of 1997
Department of Agrarian Reform
Center for Land Use Policy, Planning and Implementation
(CLUPPI)
Documentary Requirements for Land Use Conversion
A. General Requirements. Five (5) Sets of the following:
1. Application for Conversion (Land Use Conversion (LUC) Form No. 1)
2. Special Power of Attorney, if the petitioner is other than the owner of the land
3. True copy of the Original Certificate of Title (OCT) or Transfer of Certificate of Title (TCT) certified by the Register of Deeds not later than thirty (30) days prior to filing. However, if at the time of application, the landholding is an untitled agricultural land, the following shall be required in lieu of the copy of the title:
a. DENR Certification that the landholding has been classified as alienable and disposable, and
b. Certification from either the Land Management Bureau (for administrative confirmation of imperfect title) or the Clerk of Court of regular courts (for judicial confirmation of imperfect title) that:
1. the titling process/proceedings has commenced; and
2. there are no adverse claimants.
4. Sketch Map, Vanity Map of the land duly prepared by a licensed engineer, and Area Development Plan including Work and Financial Plan, statement of justification of economic/social benefits of the project and recent 5R photographs of the property being applied for conversion.
5. Proof of financial and organizational capability to develop the land, such as:
a. Profile of developer, including details of past or current development projects
b. Financial statements duly authenticated by a certified public accountant
c. Articles of Incorporation or Partnership, if the applicant/developer is a corporation or partnership.
6. Zoning certification from the HLURB Regional Officer on the classification of the land, citing the Ordinance under which the property was reclassified and the date of its approval. (LUC Form No. 2)
7. Certification from the DA Regional Director and NIA Regional Manager stating the classification of the property under the network or Protected Areas for Agriculture and irrigation coverage of the property. (LUC Form No. 3 and 4)
8. Certification from the DENR Regional Executive Director that the area subject of conversion is not within the NIPPERS and/or environmentally critical or highly restricted area for conversion. (LUC Form No. 5)
9. Official Receipt showing proof of payment of the Filing Fee,
B. Additional requirements when the applicant is a beneficiary of the Agrarian Reform Program:
1. Certification from the Director, Bureau of Land and Acquisition and Distribution (BLAD-DARCO) that the applicant is the actual farmer-awardee, that at least five (5) years have elapsed since the award of the land to the awardee and that the obligations for the payment of the land have been fully paid (for DPSVLT) (LUC Form No. 6).
2. Certification by the Land Bank of the Philippines (LBP) in the area that the farmer-awardee has fully paid his obligations with the Land Bank of the Philippines (for LBP financed lands). (LUC Form No. 7)
C. Additional Requirements for conversion of properties falling within the areas Highly Restricted for Conversion shall be a social benefit cost analysis of the project approved by the DA and an EIA and/or ECC from the DENR.
D. An additional requirement for conversion of Priority Areas under E.O. 124 (1993) falling under the areas Highly Restricted for Conversion shall be an endorsement from NEDA-NLUC and a social benefit cost analysis of the Project approved by the DA and/or an EIA and/or ECC from the DENR
The Social Benefit Cost Analysis may be waived if the priority area falls within those highly restricted from conversion, in the exercise of sound discretion by the DAR, but the EIA or ECC shall always be required.
LUC FORM NO. 1 APPLICATION NO. __________
Series of 1997 Filing Fee Paid Under:
(To be filled-up by the applicant) O.R. No.: __________
Date: ______________
Amount: ____________
SWORN DECLARATION/APPLICATION FOR CONVERSION*
The Honorable Secretary
Department of Agrarian Reform
Quezon City
S i r :
Pursuant to DAR Administrative Order No. _____, Series of 19__, I hereby apply for the conversion of the landholding/s from agricultural to _____________ use/s and submit the following information: DcCITS
I. APPLICANT'S PERSONAL CIRCUMSTANCES
A. Landowner
(If the applicant is the landowner)
Name ___________________________________________________
Address _________________________________________________
Postal Address ____________________________________________
Telephone Number ________________________________________
B. Representative
(If the applicant is other than the landowner)
Name ___________________________________________________
Address _________________________________________________
Postal Address ____________________________________________
Telephone Number ________________________________________
Nature of Authority (To be attached):
[ ] SPA [ ] Board Resolution
To be submitted by the applicant to the DAR Regional CLUPPI (RCLUPPI) or Central office CLUPPI together with pertinent documentary requirements as in the attached list in five (5) copies (1 set original and 4 sets of photocopy). All applications covering a total of more than five hectares shall be filed with the CLUPPI. Applications for landholdings with an aggregate area of five (5) hectares and below on a project basis shall be filed with the RCLUPPI. For the purpose of determining the aggregate area involved, the area of the application/s regardless of the number of land use conversion applications and below on a project basis shall be filed with the RCLUPPI. For the purpose of determining the aggregate area involve, the area of the applications regardless of the number of land use conversion applications or folders shall mean the total area of all applications involving:
1. Properties owned by the same person/s or entity or the owners of which are represented by the same person or entity, and
2. Properties located in the same barangay or adjacent barangay within the same Municipality/ies.
In cases where the subject matter of the applications is adjacent to areas where the DAR has previously issued conversion orders the test above on the determination of aggregate areas shall be applied for purposes to determining the approving authority.
Control No.: ____________
II. LAND DEVELOPER
(to be filled-up regardless of whether or not the developer is the applicant. Please attached contract for the development of the property, if the developer is other than the applicant)
Name ________________________________________________________
Address ______________________________________________________
Postal Address _________________________________________________
Telephone Number ______________________________________________
License/Registration Number ______________________________________
III. DESCRIPTION OF LANDHOLDING/S
A. Land Title/s and Area Applied
(Attached corresponding true copy of Land Title/s as certified by the Register of Deeds)
Registered Lot OCT/TCT Area Per Area Applied for
Owner No. No. Title Conversion (Has.)
(Has.)
1. ___________ _____ ________ _________ _________
2. ___________ _____ ________ _________ _________
3. ___________ _____ ________ _________ _________
4. ___________ _____ ________ _________ _________
5. ___________ _____ ________ _________ _________
TOTAL _________
B. Location: _____________________________________________
(Barangay, Municipality, Province)
C. The area for conversion has not been covered or issued by any of the following CARP distribution/acquisition schemes, such as:
[ ] Notice of Acquisition;
[ ] Voluntary Offer to Sell;
[ ] Application for Stock Distribution, or
[ ] Voluntary Land Transfer.
D. Existing Land Cover and Use
Land Cover Land Use Area (Has.)
(e.g., grass, crops structures)
i. Dominant _______________ __________ ___________
ii. Others _______________ __________ ___________
E. Surrounding Land Cover and Use
Land Cover Land Use Area (Has.)
i. Dominant _______________ __________ ___________
ii. Others _______________ __________ ___________
F. Approximate Distance (in Km.) to any of the following:
Municipal Hall ___________ Barangay Center ______________
Public Market ____________ Public School ________________
National Highway _________ Provincial Road ______________
Municipal Road ___________ Barangay Road _______________
(Please attach Location and Vicinity Maps)
G. Tenurial Status: (Pls. Check)
[ ] Tenanted [ ] Untenanted
[ ] With Farmworkers [ ] Without Farmworkers
[ ] With Occupants [ ] Without Occupants
(Pls. attach list of affected tenants, farmworkers or occupants, if any)
H. Encumbrances: [ ] Yes [ ] None
If yes, specify type of encumbrance ________________________
If covered with several land titles, specify OCT/TCT Nos. _________________
I. Finally, no similar/previous application has been filed, in my name or in my behalf over the same or portion of the area for, and this application is not part of a bigger project involving other landholdings.
IV. SWORN STATEMENT
I hereby certify that all information stated above 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 conversion approval and blacklisting of my perm or my representative form any dealings with the DAR.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day of ______, 199__ at ______________________________.
____________________________
Signature Landowner/Representative
SUBSCRIBED AND SWORN to before me this ______ day of ____, 199___ at _____________________________________________. Landowner/Representative exhibiting his/her Residence Certificate No. ____________ issued on ______________ at ________________________.
_____________________
Notary Public
Doc. No. _________
Page No. _________
Book No. ________
Series of 199___
Attachments: List of Standard Documentary, Requirements; LUC Forms that are to be filled-up by applicant and concerned agencies.
LUC FORM NO. 2 HLRB Region __________
Series of 1997
(To be filled-up by the Regional HLRB)
Republic of the Philippines
HOUSING AND LAND USE REGULATORY BOARD
Office of the Regional Officer
ZONING CERTIFICATION
This is to certify that the ____________ parcel(s) of land situated in Barangay(s) ___________ Municipality of __________________ Province of ____________________, covering an area of __________________ hectares, specifically identified as follows:
Regional Owner Lot OCT/TCT Area Per Area
No. No. Title applied for
Has. Conversion
Has.
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
which will be subject of the application for land use conversion of ________________, petitioner is/are zoned for _____________ use per Town Plan/Zoning Ordinance of the city/municipality of _____________________, dated __________ ratified by the Housing and Land Use Regulatory Board/Sangguniang Panlalawigan through _______________ dated ________ in accordance with Memorandum Circular No. 54 Series of 1993 and Section 20 of the Local Government Code and related issuances.
Issued this ________ day of ________, 199__ upon the request of Mr./Mrs./Ms. ________________________________________________.
Regional Officer
Note: 1. This certification is issued relative to the requirement of DAR regarding the implementation of the Comprehensive Agrarian Reform law and shall not be construed as a Certificate of Eligibility for Conversion;
2. This certification shall not be construed as a Location Clearance/Certificate of Zoning Conformance or Development Permit; and
3. This shall not be construed as a certification as to the ownership by the applicant of the abovelisted parcel(s) of land.
Control No. ____________
LUC FORM NO. 3 DA Region _____________
Series of 1997
(To be filled-up by the DA)
Republic of the Philippines
DEPARTMENT OF AGRICULTURE
Office of the Regional Director
This is to certify that the ___________ parcel(s) of land situated in Barangay(s) __________________ Municipality of _________________ Province of ___________________, covering an area of _____________ hectares, specifically identified as follows: cIHCST
Regional Owner Lot OCT/TCT Area Per Area
No. No. Title applied for
Has. Conversion
Has.
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
Pursuant to Department of Agriculture Administrative Order No. _______________, Series of _____________, its Network and Map if Protected Areas, and upon the conduct of actual field evaluation and verification, the subject landholding has been found to be:
1. __________ Non negotiable for conversion
__________ Irrigated land where water is available to support rice and other crop production but are within areas programmed for irrigation facility rehabilitation by the DA and the NIA, pursuant to Presidential Administrative Order 20
__________ All irrigable lands already covered by irrigation projects with firm funding commitments
2. __________ Highly Restricted from Conversion
__________ irrigable land not covered by irrigation projects with firm funding commitments
__________ agro-industrial croplands (presently planted to industrial crops)
__________ highlands
Control No. ____________
3. __________ Eligible for Conversion
__________ potential agro-industrial lands
__________ expansion areas
__________ erodible land (agro-forestry)
__________ pasture land
__________ wetlands
_______________
Regional Director
LUC FORM NO. 4 Region ______________
Series of 1997
(To be filled-up by the NIA)
Republic of the Philippines
NATIONAL IRRIGATION ADMINISTRATION
Office of the Regional Irrigation Manager
This is to certify that the ______________ parcel(s) of land situated in Barangay(s) ____________________ Municipality of Province of ____________, covering an area of ______________ hectares, specifically identified as follows:
Registered Lot OCT/TCT Area Per Area
Owner No. Case No. Title Applied for
(Has.) Conversion
(Has.)
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
Are found to be:
1. ___________ Within irrigated lands where water is available to support rice and other crop production;
___________ Outside irrigated lands and water is not available to support rice and other crop production;
2. ___________ Within areas programmed for irrigation facility rehabilitation;
3. ___________ Within irrigable lands already covered by irrigation project with firm funding commitments (i.e., there is an existing bilateral to multilateral agreements and/or included in the agency's program);
4. ___________ Not irrigable lands and not covered by irrigation project with firm funding commitment.
5. ___________ Others: ____________________________________
This certification is issued upon the request of Mr./Mrs./Ms. ________. Given this day of ___________, 199___.
_________________
Regional Manager
NOTE: When accomplished, this CEC is to be attached in the Application for Land Use Conversion (LUCF) as one of the standard documentary requirements
Control No. ____________
LUC FORM NO. 5 DENR Region ________
Series of 1997
(To be filled-up by the DENR)
Republic of the Philippines
DEPARTMENT OF ENVIRONMENT AND NATURAL
RESOURCES
Office of the Regional Executive Director
This is to certify that the ___________ parcel(s) of land situated in Barangay(s) _______________ Municipality of _________________ Province of _______________, covering an area of hectares, specifically identified as follows:
Registered Lot OCT/TCT Area Per Area
Owner No. Case No. Title Applied for
(Has.) Conversion
(Has.)
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
FURTHER, it is certified that the landholdings applied for are:
1. __________ protected areas under the National Integrated Protected Areas (NIPAS)
2. __________ watershed and/or recharged areas of aquifers
3. __________ areas identified as environmentally critical pursuant to PD 1586 and DENR AO 96-37
4. __________ do not fall under any of the categories abovementioned (3s 1-3)
This certification is issued upon the request of Mr./Mrs./Ms. __________ Given this day of ____________ 199___.
_________________
Regional Manager
NOTE: When accomplished, this CEC is to be attached in the Application for Land Use Conversion (LUCF) as one of the standard documentary requirements
Control No. ____________
LUC FORM NO. 6
Series of 1997
(To be filled-up by the BLAD)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
CERTIFICATE OF AGRARIAN REFORM PROGRAM AWARDEE
This is to certify that the ___________ parcel(s) of land situated in Barangay(s) ______________ Municipality of _____________________, Province of _________________, covering hectares, specifically identified as follows:
Registered Lot OCT/TCT Area Per Area
Owner No. Case No. Title Applied for
(Has.) Conversion
(Has.)
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
FURTHER, it is certified that the subject land is found to be covered and distributed under the Agrarian Reform Program and awarded to the following farmer-beneficiaries.
1. _________________ 6. ________________
2. _________________ 7. ________________
3. _________________ 8. ________________
4. _________________ 9. ________________
5. _________________ 10. ________________
(attach list of necessary)
FURTHERMORE, at least five (5) years have lapsed since the award of the land to the abovementioned farmer-beneficiaries and the obligation of the former awardees have been: HDICSa
[ ] fully paid [ ] not fully paid [ ] under LBP financing
CERTIFIED BY:
______________
BLAD Director
NOTE:
1. This CEC shall be required when the applicant/landowner is a beneficiary of agrarian reform program; and
2. Accomplished copy of this CEC is to be attached to the Land Use Conversion Folder (LUCF) as one of the additional requirements.
Control No. ____________
LUC FORM NO. 7
Series of 1997
(To be filled-up by the LBP Branch/Field Manager)
Republic of the Philippines
LAND BANK OF THE PHILIPPINES
Office of the Branch/Field Manager
Branch/Field Office ______________
______________________________
CERTIFICATE OF FULL PAYMENT OF ARB's OBLIGATIONS
This is to certify that the ____________ parcel(s) of land situated in Barangay(s) _____________ Municipality of ___________________ Province of _________________, covering an area of ___________ hectares, specifically identified as follows:
Registered Lot OCT/TCT Area Per Area
Owner No. Case No. Title Applied for
(Has.) Conversion
(Has.)
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
FURTHER, it is certified that the subject landholding/petition was found to be awarded to the following farmer-beneficiaries, namely:
1. _________________ 6. _________________
2. _________________ 7. _________________
3. _________________ 8. _________________
4. _________________ 9. _________________
5. _________________ 10. _________________
(attach list of necessary)
FURTHERMORE, the abovementioned farmer-beneficiaries of the agrarian reform program have [ ] fully paid [ ] not fully paid their obligations.
This certification is issued upon the request of Mr./Mrs./Ms. __________________________. Given this ____________ day of _______ 199___.
____________________
Branch/Field Manager
Note:
1. This CEC shall be required when the applicant/landowner is a beneficiary of agrarian reform program; and
2. Accomplished copy of this CEC shall be attached to the Land Use Conversion Folder (LUCF) as one of the additional requirements.
Control No. ___________
(To be filled-up by Receiving Officer) LUC FORM A
Republic of the Philippines
Department of Agrarian Reform
Center for Land Use Policy, Planning and Implementation (CLUPPI)
Office (Central/RCLUPPI): ____________
CHECKLIST FOR APPLICATION FOR LAND USE CONVERSION OF ALL PRIVATE AGRICULTURAL LANDS
A. PETITIONER
1. Name of Applicant: _________________________________ (Signatory in the Sworn Declaration/Application for Conversion)
2. Date of Filing of Petition: ______________________________
3. Proposed Use of the Land: ____________________________
4. Total Area Applied for Conversion (in hectare): ____________
Location of the Property: ______________________________
5. Name of Developer: __________________________________
Address: ___________________________________________
Tel. No.: ___________________________________________
If the developer is not the applicant, specify proof of authority to develop the land:
__________________________________________________
B. LANDHOLDING INFORMATION
1. Title Tax Date of Area
Name of No./ Declaration Registration Per
Registered Case No. No. of Title Title
Landowner/s
_________ ______ _________ _________ ________
_________ ______ _________ _________ ________
_________ ______ _________ _________ ________
_________ ______ _________ _________ ________
_________ ______ _________ _________ ________
2. If land is tenanted : (Check)
[ ] proof of payment of disturbance compensation (acknowledgement receipt by tenant/farmworker), attested by BARC or Brgy. Chairman and MARO; or
[ ] proof of undertaking to pay disturbance compensation (duly notarized agreement signed by tenant/farmworker and applicant, embodying undertaking of applicant to pay disturbance compensation)
Control No. ____________
Type o f Document With Without
Document Document
1. Notarized Application of conversion _______ ________
(LUC Form No. 1)
2. SPA (if applicant is other than the _______ ________
owner)
3. Photocopy of TCT/OCT Certificate _______ ________
by ROD not later than 30 days prior
to filing; if the property is untitled:
— DENR certification that the property _______ ________
is alienable & disposable; and
— Certification from the Clerk of Court/ _______ ________
LMB that: a) the titling process/
proceedings has commenced; b) there
are no adverse claimants
4. Sketch map _______ ________
5. Vicinity map, preferably prepared by a _______ ________
Duly licensed Geodetic Engineer
6. Area Development Plan _______ ________
7. Work and Financial Plan _______ ________
8. Justification of Economic and Social _______ ________
Benefits
9. Photos of the Property _______ ________
10. Proof of financial and organizational _______ ________
capability to develop the land, such as:
[ ] Profile of developer including details _______ ________
of past or current development projects
[ ] Financial Statements duly authenticated _______ ________
by a certified public accountant
[ ] Articles of Incorporation or Partnership, _______ ________
if the applicant/developer is a corporation
or partnership
11. HLRB Certification Regional Officer
(LUC Form No. 2)
That the property is zoned for its proposed _______ ________
use citing the date of approval of the Town
Plan/Zoning Ordinance of the city/
municipality concerned and date of approval
by Sangguniang Panlalawigan or HLURB
12. DA Certification (LUC Form No. 3)
Ø Non-negotiable area _______ ________
Ø Highly restricted from conversion _______ ________
Ø Eligible for conversion _______ ________
13. NIA Certification (LUC Form No. 4)
Whether or not the area is/are:
Ø Within irrigated lands where _______ ________
water is available to support rice
and other crop production
Ø Outside irrigated lands and water _______ ________
is not available to support rice
and other crop production
Ø Within areas programmed for _______ ________
irrigation facility rehabilitation
Ø Within irrigable lands already _______ ________
covered by irrigation project with
firm funding commitments (i.e., there
is an existing bilateral to multilateral
agreements and/or included in the
agency's program)
Ø Not irrigable lands and not covered _______ ________
by irrigation project with firm
funding commitment.
14. DENR Certification (LUC form No. 5)
Whether or not the subject landholding is/are:
Ø Protected areas under the National _______ ________
Integrated Protected Areas (NIPAS)
Ø Watershed and/or recharged areas _______ ________
of aquifers
Ø Areas identified as environmentally _______ ________
critical pursuant to PD 1586
and DENR AO 96-37
Ø Do not fall under any of the _______ ________
categories abovementioned (#s 1-3)
15. Application Fee
16. If the applicant is an FB of the CARP:
_______ Certification from the DAR that _______ ________
the applicant is the actual farmer-
awardee, and at least five (5) years
have lapsed since the award of the
land to him and full payment of
obligations for the payment of the
land (LUC Form No. 6)
_______ Certification issued by the LBP _______ ________
that FB has fully paid his obligations
with LBP (for LBP financed lands)
(LUC Form No. 7)
17. If application falls under areas classified as highly restricted from conversion ACETSa
_______ EIA/ECC from DENR; and _______ ________
_______ Social-Benefit Cost Analysis _______ ________
from DA
18. Others
Checked by: ________
Date: _________
LUC FORM B
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Office (Central/CLUPPI): ___________
To be filled-up by CLUPPI/RCLUPPI
ASSESSMENT OF LUC APPLICATION FILING FEE
Name of Applicant: ______________________________________________
Location of Property/Landholdings: __________________________________
Area: _________________________________________________________
Amount to be paid: ______________________________________________
Fixed Fee Variable Fee Total
_______ ________ ________
Approved for payment:
___________________________
Authorized CLUPPI/RCLUPPI
Representative
To be filled up by ACCOUNTING DIVISION
ORDER OF PAYMENT
DATE: __________
PAYOR ______________________________________________________
PARTICULAR _________________________________________________
FUND ________
JOURNAL ENTRIES
Account Symbol Debit Credit
_____________ __________ _________________
_____________ __________ _________________
_____________ __________ _________________
_____________ __________ _________________
Obligation No.
Deposit to: BTR ( ) Trust ( )
O.R. No. __________ DATE: ____________
Amount ___________ ______________
Collecting Officer Chief Accountant
CONTROL NO.: ________
LUC FORM C
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Central Office/Region __________
MEMORANDUM
TO : MARO __________________
Municipality of _____________
SUBJECT : POSTING OF NOTICE OF CONVERSION
1. Please be informed that __________________ filed an application for conversion described in the attached Notice of Land Use Conversion Application.
2. In this regard, you are hereby instructed to post the attached Notice of Conversion Application in conspicuous places for the information of all concerned.
_________________________
Head, CLUPPI Secretariat/
Chairman, RCLUPPI
Copy Furnished:
PARO ______________
Province of ___________
CONTROL NO. _________
LUC FORM D
(To be filled up by the CLUPPI/RCLUPPI
and to be posted by the MARO)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Office (Central/RCLUPPI): _____________________
NOTICE OF LAND USE CONVERSATION APPLICATION
NOTICE is hereby given that ____________ has filed with DAR an Application for Land Use Conversion over __________ parcel/s of land situated in Barangay _______________, Municipality of ____________, Province of ____________________, covering an area of _____________-hectares, specifically identified as follows:
Registered Lot OCT/TCT Area Per Area Applied
Owner No. Case No. Title for Conversion
(Has.) (Has.)
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
TOTAL ______ __________ __________ __________
The above parcels are sought to be converted from agricultural to __________________ use.
Any person with valid objection to the said application for land use conversion may file his/her objection/protest thereto, in writing, addressed to the Head, CLUPPI/RCLUPPI Secretariat through the Municipal Agrarian Reform officer, not later than fifteen (15) days from the Period of Posting. The Period of Posting shall be completed after fifteen (15) days.
______________________________
Head, CLUPPI/RCLUPPI Secretariat
Posted by: ____________ Date: ______________
MARO
Note: Accomplished copy of this Notice is to be attached in the Application for Land Use Conversion while duplicate copies shall be posted at the Barangay hall, Municipal Hall and in conspicuous premises of the land sought to be converted.
CONTROL NO. _________
LUC FORM D
(To be filled up by CLUPPI/RCLUPPI)
and to be posted by the MARO)
PASKIL HINGGIL SA PAGPAPALIT-GAMIT NG LUPA
Sa pamamagitan ng paskil na ito, ipinagbibigay-alam na si _______________ -ay nagsumite sa Kagawaran na Repormang Pansakahan ng Aplikasyon para sa pagpapalit ng Gamit ng Lupa na sumasakop ng _____________ ng parsela ng lupa sa Barangay ____________, Bayan ng _____________, Lalawigan ng _____________ na may kabuuang lawak na ________________ -ektarya na tukoy na kinilala ayon sa sumusunod:
Nakarehistrong Numero OCT/TCT Sukat Lawak ng
May-Ari ng ng Lote Case No. Kada Lupang Nais
Lupa Titulo Ipapalit-Gamit
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ Kabuuang Lawak __________
Ang mga nasabing parsela ay hangad na ang gamit-lupa nito ay maging pang-________________________ mula sa kasalukuyang gamit pansakahan.
Sino man ang may lehitimong pagtutol sa nasabing aplikasyon para sa pagpapalit gamit ay maglahad ng kanyang pagtutol o protesta sa pamamagitan ng kasulatang ipinapaabot sa Punong Tagapagpaganap ng Sentrong Pampatakaran, Pagpaplano, at Pagpapatupad I-hinggil sa Gamit-Lupa nang hindi hihigit ng ika-labinlimang (15) araw mula ng Panahon ng Pagpapaskil. Ang panahon ng pagpapaskil ay matatapos sa loob ng labinlimang (15) araw mula sa petsang nakasaad sa ilalim.
____________________________________
Punong Tagapagpaganap, CLUPPI/RCLUPPI
Ipinaskil ni: _____________ Noong: ______________
MARO Petsa
Paalala: Isang sipi nitong napunuang Paskil Pambigay-Alay ay isasama sa Aplikasyon para sa Pagpapalit-Gamit na Lupa habang ang mga tulad-sipi ay tig-isang ipapaskil sa Bulwagang Pambarangay, bulwagang Pambayan at sa isang panukulan sa loob ng lupaing hangad na palitan ng gamit-lupa na madaling mapansin ng madla.
CONTROL NO. _________
LUC FORM E
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Office (Central/RCLUPPI): ____________
CERTIFICATION ON POSTING OF NOTICE OF LAND USE CONVERSION APPLICATION
This is to certify that the Notice of Land Use Conversion Application of the property owned by _________________ involving ______________ hectares of land situated at Barangay ________________, Municipality of _____________, Province of _______________ has been posted at the: ETISAc
Barangay Hall on ___________________
Municipal Hall on __________________
Premises of the land sought to be converted on __________________
___________________________
Municipal Agrarian Reform Officer
____________________
Date
Note: Should be accomplished by the MARO at the start of posting.
CONTROL NO. _________
LUC FORM F
(To be filled up by the CLUPPI/RCLUPPI)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation (CLUPPI)
Center for Land Use Policy, Planning and Implementation
Office (Central/RCLUPPI): _________________
EVALUATION SHEET
A. PETITIONER
1. Name of Applicant: _________________________________
(Signatory in the Sworn Declaration/Application for Conversion)
2. Date of Filing of Petition: _____________________________
3. Proposed Use of the Land: ____________________________
4. Total Area Applied for Conversion (in hectare): ____________
Location of the Property: _____________________________
5. Name of Developer: _________________________________
Address: __________________________________________
Tel. No.: __________________________________________
If the developer is not the applicant, specify proof of authority to develop the land:
____________________________________________
B. LANDHOLDING INFORMATION
1. Title Tax Date of Area
Name of No./ Declaration Registration Per
Registered Case No. No. of Title Title
Landowner/s
__________ ______ _________ _________ _________
__________ ______ _________ _________ _________
__________ ______ _________ _________ _________
__________ ______ _________ _________ _________
__________ ______ _________ _________ _________
2. With encumbrance/s [ ] Yes [ ] No
If yes, specify type of encumbrance/s _________________________
if covered with several land titles, specify OCT/TCT Nos. _________
[ ] With concurrence of the mortgagee
[ ] Without concurrence of the mortgagee
3. If land is tenanted: (check)
[ ] proof of payment of disturbance compensation (acknowledgement receipt by tenant/farmworker), attested by BARC or Brgy. Chairman and MARO; or
[ ] proof of undertaking to pay disturbance compensation (duly notarized agreement signed by tenant/farmworker and applicant, embodying undertaking of applicant to pay disturbance compensation)
Type of Document Name of Date Sufficient Not
Issuing Issued Sufficient/
Officer Remarks
1. Notarized Application of ______ ______ ______ ______
Conversion (LUC Form No. 1)
2. SPA (if applicant is other than ______ ______ ______ ______
The owner)
3. Photocopy of TCT/OCT Certified ______ ______ ______ ______
by ROD not later than 30 days
prior to filing; if the property is
untitled
— DENR certification that ______ ______ ______ ______
the property is alienable
& disposable; and
— Certification from the
Clerk of Court/LMB that:
a) the titling process/
proceedings has commenced;
b) there are no adverse claimants
4. Sketch map ______ ______ ______ ______
5. Vicinity map, preferably prepared ______ ______ ______ ______
by a duly licensed Geodetic
Engineer
6. Area Development Plan ______ ______ ______ ______
7. Work and Financial Plan ______ ______ ______ ______
8. Justification of Economic and ______ ______ ______ ______
Social Benefits
9. Photos of the Property ______ ______ ______ ______
10. Proof of financial and ______ ______ ______ ______
Organizational capability to
develop the land, such as:
[ ] Profile of developer ______ ______ ______ ______
including details of past or
current development projects
[ ] Financial Statements duly ______ ______ ______ ______
authenticated by a certified
public accountant
[ ] Articles of Incorporation ______ ______ ______ ______
or Partnership, if the applicant/
developer is a corporation or
partnership
11. HLRB Certification Regional
Officer (LUC Form No. 2)
That the property is zoned for ______ ______ ______ ______
Its proposed use citing the date
Of approval of the Town Plan/
Zoning Ordinance of the city/
Municipality concerned and date
of approval by Sangguniang
Panlalawigan or HLURB
12. DA Certification (LUC Form No. 3)
Ø Non-negotiable area ______ ______ ______ ______
Ø Highly restricted from ______ ______ ______ ______
conversion
Ø Eligible for ______ ______ ______ ______
conversion
13. NIA Certification (LUC Form No. 4)
Whether or not the area is/are:
Ø Within irrigated lands ______ ______ ______ ______
where water is available
to support rice and other
crop production
Ø Outside irrigated lands ______ ______ ______ ______
and water is not available
to support rice and other
crop production
Ø Within areas programmed ______ ______ ______ ______
for irrigation facility
rehabilitation
Ø Within irrigable lands ______ ______ ______ ______
already covered by irrigation
project with firm
funding commitments (i.e., there
is an existing bilateral to
multilateral agreements and/
or included in the agency's
program)
Ø Not irrigable lands and ______ ______ ______ ______
not covered by irrigation
project with firm
funding commitment.
14. DENR Certification (LUC form No. 5)
Whether or not the subject landholding is/are
Ø Protected areas under
the National Integrated
Protected Areas (NIPAS)
Ø Watershed and/or recharged
Areas of aquifers
Ø Areas identified as
environmentally critical
pursuant to PD 1586 and
Ø Do not fall under any
of the categories above
mentioned (#s 1-3)
15. Application Fee
16. If the applicant is an FB of the CARP:
> Certification from the
DAR that the applicant
is the actual farmer-
awardee, and at least five (5)
years have lapsed since
the award of the land to
him and full payment of
obligations for the payment
of the land (LUC Form No. 6)
> Certification issued by
the LBP that FB has fully
paid his obligations with
LBP (for LBP financed lands)
(LUC Form No. 7)
17. If application falls under areas classified as highly restricted from conversion
> EIA/ECC from DENR; and
> Social-Benefit Cost Analysis from DA.
18. Others
C. COMMENTS
______________________________________________________
______________________________________________________
______________________________________________________
Evaluated by: __________
Date: __________
LUC FORM G
(To be filled up by the
CLUPPI/RCLUPPI)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for land Use Policy, Planning and Implementation
Office (Central/CLUPPI); ___________
Radio Message
FOR : PARO _____________
Province of ____________
FROM : ___________________________
Head, CLUPPI/RCLUPPI Secretariat
SUBJECT : CONDUCT OF OCULAR INSPECTION
DATE : __________________________
Please be informed that CLUPPI/RCLUPPI members will conduct ocular inspection on _________ on the property being applied for land use conversion by _______ located at Brgy. ___________, Municipality of _________, Province of _______________.
Please advise the concerned MARO to make himself available on the said date to accompany CLUPPI/RCLUPPI members at the site. CLUPPI/RCLUPPI members will proceed to the MARO Office before proceeding to the area.
APPROVED FOR TRANSMISSION:
_____________________
Head, CLUPPI/RCLUPPI
CONTROL NO. _________
LUC FORM H
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Office (Central/CLUPPI); ___________
CERTIFICATION ON CONDUCT OF FIELD INVESTIGATION
This is to certify that the CLUPPI/RCLUPPI Field Investigation Team composed of ___________________ has conducted a thorough field investigation-verification on ______________, pursuant to DAR A.O. No. ______, Series of ______, in relation to the application for:
[ ] Land Use Conversion
[ ] Exemption/Exclusion
[ ] Lifting of notice of Acquisition
Filed by ____________________ on _____________ over parcels of land with TCT/OCT No/s. _____________ covering an aggregate area of ___________ hectares more or less situated in Brgy. ___________, Municipality of ____________ Province of _____________________.
_____________
MARO
_____________
Date
CONTROL NO. _________
LUC FORM I
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Office (Central/CLUPPI);__________
CERTIFICATION ON TENANCY/NON-TENANCY AND CARP COVERAGE/NON COVERAGE
The undersigned certifies that the landholding/s described hereunder:
Registered OCT/ Lot Area Location/Brgy.
Owner TCT No. (Ha.)
No/s.
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
Is/are found to be:
q Untenanted
q Tenanted
q With farmworker; No. of Farmworkers ________
q With Occupants; No. of Occupants ___________
and that
q Notice of Acquisition/Valuation has been issued
q No Notice of Acquisition/Valuation has been issued
q VLT Agreement has been executed between the LO and the tenants
q No VLT Agreement has been executed between the LO and the tenants
q Compulsory Acquisition has been issued by DAR
q No Compulsory Acquisition has been issued by DAR
_______________
MARO
_______________
Date
CONTROL NO. _________
LUC FORM J
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Center for Land Use Policy, Planning and Implementation
Office (Central/CLUPPI); __________
CERTIFICATION ON COMPLETION OF POSTING AND WITH PROTEST/WITHOUT PROTEST
This is to certify that the Notice for land Use Application Conversion for landholding/s described hereunder: aAEIHC
Registered OCT/ Lot Area Location/Brgy.
Owner TCT No. (Ha.)
No/s.
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
__________ ______ __________ __________ __________
involving ____________ hectares of land situated at Barangay __________, Municipality of _______________, Province of __________ was posted at:
________________ Barangay Hall
________________ Municipal Hall
________________ Premises of the land sought to be converted on __________ until ____________________.
and that:
________ there is no protest filed involving the land use conversion application
________ there is no protest filed by ________ on the said application
_______________
MARO
_______________
Date
CONTROL NO. _________
LUC FORM K
(To be filled up by CLUPPI and RCLUPPI) Application No. ______
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
FIELD INVESTIGATION — VERIFICATION REPORT
This is the result of the thorough field investigation — verification conducted on _______, pursuant to Department of Agrarian Reform Administrative Order No. 7, series of 1997, in relation to the Application of Land Use Conversion from agricultural to _______ use field on _________ by ___________ over __________ parcel/s of land described hereunder, covering an aggregate area of ___________ hectares and situated at Barangay/s __________, Municipality of __________, Province of _________.
1. The landholding/s applied for conversion is specifically identified as follows:
Registered Lot OCT/TCT Area Area Location
Owner No. No. Per Applied (Brgy.)
CASE No. Title
________ ____ ________ ____ ________ ________
________ ____ ________ ____ ________ ________
________ ____ ________ ____ ________ ________
________ ____ ________ ____ ________ ________
________ ____ ________ ____ ________ ________
TOTAL ____ ________ ____ ________ ________
2. THE LANDHOLDINGS APPLIED FOR ARE:
[ ] Contiguous [ ] Scattered
3. EXISTING LAND COVER AND USE:
LAND COVER LAND AREA
(e.g., crop, grass, structure) USE (Has.)
DOMINANT
OTHERS
CONTROL NO. _________
4. TERRAIN/TOPOGRAPHY:
TOPOGRAPHY: ELEVATION:
[ ] Flat Area: ______ [ ] Less than 500 meters
[ ] Upland Area: ______ [ ] App. 500 meters or
[ ] Hilly Area: ______ above
[ ] Mountainous Area: ______
5. SURROUNDING LAND COVER AND USE:
LAND COVER LAND AREA
(e.g., crop, grass, structure) USE (Has.)
NORTH
SOUTH
EAST
WEST
6. ACCESSIBILITY: Distance (in Kim) to any of the following:
Municipal Hall ______ Barangay Center ______
Public Market ______ School ______
National Highway ______ Provincial Road ______
Municipal Road ______ Barangay Road ______
7. Irrigability:
[ ] Irrigated [ ] Not Irrigated
[ ] With irrigation canal traversing/adjacent to the property
[ ] With irrigation system noted in the area
[ ] No irrigation system noted in the area
[ ] Others, specify: ____________________
8. AREA DEVELOPMENT:
[ ] With land development [ ] Without any land development
Specify: (e.g., road construction, excavation, drainage, tracing etc. __________)
[ ] With vertical/infrastructure [ ] Without vertical/infrastructure
development development
Specify: _____________________________
9. TENURIAL STATUS:
[ ] Tenanted No. ________ [ ] Untenanted
[ ] With farmworkers No. ________ [ ] W/o Farmworker
[ ] With Occupants No. ________ [ ] W/o Occupants
Key informant: ________________________________
(Primary Key Informants: BARC Chairman, Brgy. Chairman/official)
List of Affected Tenants/Farmworkers/Occupants:
NAME AREA CROPS
CULTIVATED/OCCUPIED PLANTED
_____________ __________________ ____________
_____________ __________________ ____________
_____________ __________________ ____________
_____________ __________________ ____________
_____________ __________________ ____________
_____________ __________________ ____________
________ With protest against land use conversion application
________ Without protest against land use conversion application
________ With proof of disturbance compensation or agreement to pay disturbance compensation
________ Without proof of disturbance compensation or undertaking to pay disturbance compensation
10. Other Issues: ______________________________
11. Based on the above findings, the application for conversion is hereby recommended for:
[ ] Approval Area (Has.) ____________
[ ] Denial Area (Has.) ____________
Subject to:
________________________________________________________
________________________________________________________
________________________________________________________
INVESTIGATION TEAM:
_______________________ __________________
(Signature over Printed Name) Date
_______________________ __________________
(Signature over Printed Name) Date
_______________________ __________________
(Signature over Printed Name) Date