list of requirements for regular application

EXPLOSI''ES MANAGEMEN'T DMISIONLice nse To Possess Exilos ives/Exp los ive I n g red ientVContro I led G hem i calso MANUFAGTURER n DEALER o PURGHASER(NEW) vALrDrw:!.vearonlv

1. tr Lstbr,squest Gigned by 0r€ aufrcdzed leprcBeotawe indicatng, amorE ofieE, heexplosivedexplGive ingedienUcontolled demicaus to be prooned, qusnlity (based oohe capacity of flek stordge facility), pu8/grade. Since tE signaby b an auhorizedrcprcsenblive, he must attadr to tE LR a certified true copy of his valkl company lD,

Boad of Dieclo/s ResolulioniDircclo/s Cedificate/SPA (tur paftErship 8nd singlepoprieb6hip). (No alteratiom by any person sxcept tE signabry hirBeff, on he LR shallbe allored);

tr Original and notadzed copy ol Boad of DirccloCs Resolution or Dir€do/s Cortficate (for

companies wih Brandr Offce in he Phllippln6 {dab should bo v{ihin thesafiE y€r as UE year ol frling)

tr SEC Regbt'ation, Artdes of lncoporaton and By{aws, General lnfoflEtion Sheet(Gls)duly autBntjcated (machine-validabd) by SEC (for corporationJparherships);DTI RegtsFation, Business Permit and C€rtificate of Capibl lnvested in fie busin€ss fromhe City or irunidpal Teasuer (for sole propdeblships); (Irb I )

tr Odginal ilBl Clsenncs otthe autllorirld npr€.€nbtive (PurpGe:PNP RequiEmenuBusiness Requir€fllenuotEr Requirernent ONLY)I

tr Signcd PoEoml HBtory S-htcqnstt of t|o rdhodzod repl! cnffive and olcompany6mploys! h.ving acclE3 to $e itorrgo hcility uh.rB erplolivElorphaiveingrodierb and/or conlrollod chomkxb ar€ storcdryiaBho6€d (nobrized and shouldcontah lhe fofiowirE infodmtioo: personal circumstanG sudr as compleb name, daband place of bifi, city address, pmyincial sddress, complets n8me, dale and placs ol birhof moher and fafEr (deceased or not); education and tahing ba*grcund; fnancial,investnent and ban hbbryi t"avel history (local and forcign); ofhnsdcrimim, rccord;addrcss hisbry (fo{ fE past 10 yeaE, please sbte indusive dates); employmentbac*ground; oeanizatbnal afilialioris {religious, socio{ivic, professional);

lhnsesiaccr€ditations, ceniicationyeliliulitiesi medical history; and handwdting

specimenjD Procsr! Florchart - D6€ription of $e prccess nor {,hslE he explosivds, €xplosive

irqedient/s and/or contoll€d dlembat/s will be used (induding tE purpose of he use olfE explciveJs, explosive lnged'enus and/or contolled dEflric€Us and he quantity/purity

rcquirement to justry ib prcflle neot mt6t be ptBpaled and signed by he pe6onaufiorized to use fie exdosive/s, explosive irurcdienus and/q contolled dlemizt/s)

Reminders:{ lhclnlctt nud b.ol.c.d ln . bld.r wih WHm T BAIaGS;bl Sc.nn.d cory of.[ doqrmd{t ln Ui. .pplkrt on iold.. ln POf

forlrd conhh.d h r rurr atrh conD.d dlac GDffOic) t tr or non.aubi rion of non(iv conaunldon tt9olB .nd odr* .teo odalrxdnmdtb will edoln.ffc.lly r lin lrr d..pp.Dv.l ot .pdlc.doo ps,l{r.flt toS.cffon. lE md lF ol RA Io. 9516.

Address of the facil

l,labdal Sabty Dab Sheet (MSDS) ftom tE suppfierls of 0rcerd6iveJexploeive ingredient/s and/or contoll€d demicausOdginal SBR (Spechl Bank Receipt)- Landbank (Tab 2)

lnspeclion Repo6 (Certification of lnspectjon of Magazine/Stordge Facility,

l4agazineJsbrage Facjlily lnspedion Ch€cklist Sumoary of lnvenbry olexplosivodexplosive ingredi€nt/s and/or contrDlled dlemi€Us, lnventory ofexplosived€xpiGive ingedienth and/or confolbd dEmicat/s, Secudty Suryey) byhe PD/CD (for Prov'lAppihant) and l&E, FEO (for NCR Applicant) (T!b 3)

Propedy hbeled pilurcs (8'x1fl in size) pdoted in pllob paper

Location map am ffoor pbn of magazine/stordg€ facility and mode of shckiogEndo6ement from PDiCD (ftr Pov'lApplicanb) (Iab,l)Nohizod 12 mn$E CoflsuMir Repod and Labst lvtoo&ty

Consumptofl Report

2.tr3.tr

trtr

4.tro

Additio.al rcquirement (F0R PURCHASER 0NLY)

AcqEdiHjon nom h€ Philiptin6 orug EnforcefiBnl Ao€rcy (POEA) (for drtlieo lsho Tduen€,Pol6si0m Psmaloaldo, SuItdc Aai, adior Hyd'odtkic fuid)

A.cr€ditalbn fom lho Fdlilizor and Pssffie Au0uity {FPA) (br €nlitrG (Ain0 Con@l€d Chimids asFedilizers)

Acceditalion fom $€ Food ad Oru$r Admjiistdion {FDA) {hr efifitios using Conboll€d CllomlCs irtbod andysb)

AccrBdilation fun ltE oeparnenl ot En€rgy (DOE) (br oniitos using Condlgd Ch6rnkds in por6tgeieralion)

Acdeditalion from lhe EnvionflEnld MerEgem€nt Euroau (6r sntilir6 ushg Cdltrollod ODmicda i6debmining dr,^{ater quality)

A.arBdilatbn tom li€ Minos and Cao6aienc€s Bucar (br mining compenh6);ArcBdihtion fom the Brreau of Foresl DeleloFrEnt tor lumto. or logging fim6);Cslifrcab of egist'atbn ol lh6 business ad cenifrcato torn te Oly or MuniiipdityT.sasuer slatjng th€ cadld inv€6ted (br blestng conlr&1o6);Copy ot he D€claralbn of R€d Erlals Prcporty ,rrre ttr€ erdo6ivos will be ls€d fuCopy d conb&t rilh MSSCO {br sdvaOols of sunken vossds).(privde U6ting rio*)i

IAIil.JFACIURER. P 25,M.MDE TER-Ptdo0.OPLnCHATER-P40O.O

Contact No

RECEIVER'VERIFIER

Received Date: _ 2015Released Date: _ 2015

Siqnature above printed name

TimeTime

AM/PM

AIWPM

Chief, License and Permit SectionReceived Date: _ 20'15

Released Date: 2015

Time: _ AM/PMTime: AM/PM

SOLEDAD E ARCISOPolice Chief lnspector

Chief, EMD

Received Date: _ 2015Releas€d Date: _ 2015

JOHN C BULALACAOPolice Senior Superintendent

Time: _ AM/PMTime: AI,UPM

Chief, FEO

Received Date: _ 2015Released Date: 2015

ELMO FRAI{CIS O SARONAPolice Chief Superintendent

Time: _ AM/PMTime: _ AYPY

Dheclor, CSG

Time:

-

AM/PMTime: AM/PM

EL]TER R SORIAPolice Director

Applicant (Company): Contact PeBon:_

Received Date: _ 2015Released oate: _ 201 5

EXPLOS'''ES MANAGEMEN- DIVISIONLicense To Possess Explo=6ives/Explosive lngredients/Fontrolled Chemicals

o MANUFAGTURER a DEALER o PURCHASER(AMENDMENT)Change of Magazine/Storage Facility Address - (CMSFA)Change of Company Name or Busineas Organization - (CCNBO)Addition/Deletion or Change in Ouantlty of Explosiv6/Explosive lngredients and/or Controlled Chemicals(ADCOEETCC)

he expb€ives/explosive ingrcdiendcontolled demlral/s lo be p{oq.,rBd, quanlity peconn6lflom he PPO (for PrcvincialApdicanb)ard leE, FEo (brNCR Applicanb)

{based oo tre capaoity of $eir sbBge tacility ve6us stocl on hand), purity/gEde. whf,l exenis€s bnitorlaljurbdk;lion based oo he bcation of$e slore€ facility);

Since trc signabry is an aufpdzed Bprcsenblive, he must afladr to he LR a cedifi€d tr Popedy hbeled pirtuE (8'x10' in size) pdnted in phob paper and debil€dtue copy ol hb valii company lD and Boad of oircdo/s ResolutionlDiiedois Location map of rnagazine

Power of Atborey (for palulelships aod sole prcpriebEhips), as p.oof of hb aufErity

himsef, on dE LR shall be allq*€d); (grparcd aod signed by li$se applicant and revie'r€d and signed by pNp p€Isonn€l ,rDm

tr olsimr and nobrized copy or Board or DirBdo/s Resorution {date shourd be wihin rE *ii# lfJr:H*t#Fil:)#r$t;ffitffi"clj,'dl"nb) whidr erercbes

same year as he year ol filirE) (oflly when any one ol tre auhoriz€d reprEsenbtjveshas resilned, 0r has been rcplaced or terminated by tE company); 3.4) lnventory of explosiv6/s, expbsive irE rcdienus and/or controlled dlemicaus, (pEpared and

E sEc Resist'arbn, Arrides or rncopo'arion, cenenar rnrollmrbn sheet (crs) and By.raws Bflffi Hr1ff[i'ffii#lE'ffi#,ilfl ffi,*?'-tilI#ffif,]*:i' (b|.

duly autEntijated (mad ne-validabd) by SEC (fcr comolal rJpadneEhips); DTI iurlsOifion 6,isea o, U,e locatiln ot de sbree f;citM;

R€gisadioo, Busin€ss Pemit aod Cedificate of Capitsl invesbd in tE brrsiness fromhe City or Municipality TrEasurEr (for sole prcpd€brships); {br Poy'lAppllranb)I 3.5) Secudty Suruey (coMucl€d, pEpaled aod sillned by PNP pelsonnelfrm he CPS/MPS

I vrhidl exercises bribdaljurMirion bas€d on he bcatbn o{ t€ sbrQe hcility)

2.O Prcvious Origiml L*)ense wih Original SBR fom l-andbank ol fie PhilippirEs 4. - Enoo$€rnent i'om PDCD tlor prcrmqar appdcans -,yt:IIRomlndeB:a) Oocumonb mu3t be plrc€d ln a lou6r wittr $,HITE TABBIilGS;b) Scaoned copy of rll docuttlgnb in th3 applkrtion foldor ln PDF

fonnat clnlrincd in a curitabh Conpact Dbc;c) Late or non-rubml.lion oftredI&Ie!@lh0llgL willautomrthally rolult in tllo dbapprcval of rpplhadon fid th6 impo3ilion ofsanctions pl,Ituant to S€c{oG ilE and {F of R"A. tlo. 9515,

Contacl PeEon:

3. tr lr6pedi}l Repo6:

Applicant (Company):

Address of e Facili Contact No:

3.1) Cert'ficalion of lnspec{on of Magazioe/Storage Facility (conducied, plBpaled andsigo€d by PNP peBoonelrrcm $€ PPO (for PrcvinchlApplicanb) and l&E, FEO (forNCR Appli€nb) whidr oenises tenitorial iurMirion based on be locaton of fiesbmge hcilily);

RECEIVERiVERIFIER

Released Date: _ 2015

Time: AM/PM

Time: AM/PM


Received Date 2015

Chiet Liceme and Pemit Section


Chief, EttlD

Receirred Date: _ 201 5


Time: _ AM/PM

Time: _ AM/PM


Recommend Approval: Chief, FEO


Time: _ AM/PM

Time: _ AM/PM

ELMO FRANCIS O SARONAPolice Chief Superintendent

Received Date: 2015

Approved: D, CSG

Received Dater _ 2015

Released Date: 2015

ELIIIER R SORIAPolice Director


Time: _ AI\I/PMTime: A[,]/PM

Time: _ AM/PM

Time: _ AM/PM

'1. D Lette( request (signed by he authorized rep{esentative indicating, arcogobers, the exploGivedexplosive ir€redie dcootrolled dErnid/s t0 begooied, quartity (bas€d on the capacity of $elr storage lacility),purity/grsde. Since the signatory is an authorized repres€vtAive, he muslattadr to fle LR a cedmed true mpy of his valid mrnpaly lD and Board oloheclo/s Resoiution (for corporationsyspeod Power of Atlorney (forpatuerships and sole Eoplietorships), as proof of his authodty to lransaclon behaf of said entlty. (No alterations by any peEon except the signatory

himseff, on lhe LR shall be allo^€d);

2. o original NBI Clearance of the authorized representative (PuDose:

PNP RequiremenuBusiness Requiremenuohe6) (T!b 2)

3. tr Special Bank Receipt (Land Bank of the Philippines LBP) -Manufasturrr - Php 25,000 for I yoar validityDoalor - Php 15,000 tor I year yalidityPurchasor - Php 5,000 for I yoar v8llditylMth an opdon ot 2 yoara and il yaaE renewal

Addilon l EqulrBnont:AccEdlffion trcm lh€ Phlllppino Orug Enbrcsmenf Aoeocy (PDEA) (lbr ontdo. u3lng Tolueno, Poh33ium Pennargfilb, Sultu]ic AcH .ndor

tbdrochlodc A.ld)Aocrodidon ftom lh€ F.rdli:8r rnd P6licklG tu0lority (FPA) (br .ntltLr udng Contollcd Chomh.L rr FcltilbBlr)Accndlffion from th€ Food a|d Drug. Adnlnhffion (FDA) (tur €nlr6€. u3lng Contollod Chomlcrh ln food rnalFb)Accrcdlhdon from lie oop.rhellt ot En€qy (DOEI (ior ent0o! u3ing Confollod Chomh.b ln poHr genrrddon)

Acclrdlffion from $o Enylronmdlbl lihnrgement &reau (br entde udng ConbollGd Chcmhlb in d6bmini|lg .idh.tu qullity)Ac-credlhdon from tfu llln.. .nd Gcoscienc€. &rreau (for mining companl€a);Accrldltrton from h. Bura.u ot ForGst Development (hr lumbet or logglng frmi);C.rticd. o, ltgbErdon of tho burlne.s and cettflc.te fipm $e Clty or l{unlclp.lltyTrcrunr 3t!0ng tte crpltll lnvo.ted (6r bhsting conEactor!);Copy of tho thchrdlon ot Rcll Estde Property v{erc the exploliver wtll be u3€d bt(prlYals blrlung rYo]f);Copy ol contlc{ wlth ilASSCo (br $lvagelt ol sunken yes3els).

Reminder Late or non-submission of ElE[E-ee[SOIleOIlIefl and other r€porlorial requirsments will automaticelly result in thedisapproval of the applicstion and the imposition of sandions puGusnt to Sections 4E and 4F of R.A. No. 9516

Contact Pelson:

Address of the storage facility Contact No:

RECEIVER/VERIFIER

Received Date 20'15 TimeTime

AM/PMAM/PMReleased Date: _ 2015

Signature above printed name

Chisf, Licsnso and Permit Soction

Received Date: 2015Released Date: _ 20'15

SOLEOAO E ARCISOPolice Chief lnspector

Chisf, EilD

Time: _ Ai,l/PMTime: _ Atl/PM

JOHN C BULALACAOPolice Senior Supenntendent

Chief, FEO

Received Date:

Released Date:

20152015

Time:

Time:AM/PMAM/PM

ELI'O FRANCIS O SARONAPolice Chlef Superintendent

EXPLOSIUS MANAG EMENIJIVISIONLicense To Possess Explosives/Explosive lngredients/Controlled Chemicals

o MANUFACTURER O DEALER tr PURCHASER(RENEWAL)

Applicant (Company):

3. O lnspectm Reports (Certfication of lnspeclion of MagazindstoGge Facility,

Magazindstoragp Facility Inspectron Checklist, Summary o, lnvenlory ofexdosives/exdosive ingrcdi€nus and/orcontrolied dremicaus, lnventory ofexplosivedexplosive ingredi€r s ad/or contlolled dremicaus, SeqrntySurvey) by the P0/C0 (for Pror'l Applicant) and l&E, FEO (for NCRApplicant) (T!b 3)

tr Propedy labeled pictures (8110' in size) prinled in pholo paper and detailed

Localion plan of magazine

tr Nolarizod 12 nonths Consumplion Report and Lalesl Monthly ConsumptionReporl

O Delivery Receipt (photocopy)

4, 0 Endorsement tom PD/CD (fo. Prov'l Applicants)

odglnd.nd notrdzed copy of Boad of Dlructodr R3.olullon (dale should be

within th€ same year s the year o{ filing) (only sfton rny one ol tholulhodzed roprsaenffivo. hat rcalgnod, or haa boon]lpl.cadlbrmlnlH by the comprny);

Time: _ AI\,|/PM

Time: _ 4YPY


EXPLOSIV-S MANAGEMEN- DIVISION\-/vL|CENSE TO POSSESS EXPLOSM - FOREMAN BLASTER (NEW)

l. C Letter request of applicsnt (State Purpos€) (IAB 1). ogln l 3. tr Certification from the emdoyer which has an explosives lic€nse (IAB 3)

tr original Clearances: (NBl and PNP Dl Clearance) OAB l) tr Ce{tificate oI being capable of handling explosives hom cenmed/licensed

tr Drug Test OAB l)- ogin t mining engineer (if applicant is not a licens€d mining engine€r) fiAB 3)

tr Recent lD piclure of the licensee (&2) (IAB t) /t tr EndoG€ment Ircm ROPD & PD/CD (for Prov'l Apdicant) (IAB r)& TDI emo, tlay 26, 2010 (PBoC R.qul]€mcnt) tr Endo6erent from Bureau of Mines (if company is a mining firm) OAB I)D Updated copy of applicant's Personal History Stat€ment (PHS) with recent

pholograph OAB l)tr Ten{dnt taken by PNP Crim€ Labomtory GAa l)O Brief statement of hls blasling procedure OAB l)tr ftotographs and description of biasting equipment being use O B l)

2. tr PNP Form No. 6 duly mrnplished 0AB 2)

tr furchas€is License of the employer 0AB 2)

llob: A Pk. submlt r€qui.rmenb !r indksH rt0r RED TABBIIIGS Om S€tr of FoHer)B. Odgin l$sLlB f Rsbt(LBP)- Php 2,50010 upon rpprovll

Applicant

Address Contact Nos:

ROUTE REMARKS

I, LICENSE AND PERiIIT SECTION, EMO

Receiving Clerk :

Date/Time ReceivedDate/Time Released

Clerk Signature

Processing Section

Processor Siqnature:

Chiof, License and Permit SoctionDate/Time ReceivedDater'Time Released

SOLEDAD E ARCISOPolice Chief lnspectorChief, License and Permit Sec

2. CHIEF, EXPLOSIVES MANAGEMENT OIVISION

Date/Time Received:

Date/Time Released:

JOHN C BULALACAOPolice Senior SuperintendentChiel EMD

3. AC, FEO

Dat€/Time Received:Dateffimo Released:

ABAD H OSITPolice Senior SuperintendentAC, FEO

4. C, FEO

ELMO FRANCIS O SARONAPolice Chief SuperintendentC, FEO

5. D, CSGDate/Time ReceivedDate/Time Released

O, CSG

F4SGFEOE D-068-2011

Dateffime Received: _Date/Time Released:

DatdTime Received: _Date/Time Released: _

EXPLOSIVES MANAG EMENTDIVISIONLTCENSE TO POSSESS EXPLOSTVE - FOREMAN BLASTER (RENEWAL)

l.oDtrtrtr

2.Otrtr

Letter request of applicant (State Purpce) (IAB l)original Clearancesr (NBl and PNP Dl Cle3rance)(tAB r)orug Test OAB t)Rece piclure of the licensee (42) fi 8l)Certification of safety handling from a licensed Mining Engineer to indude

photocopy of udated PRC Uceose FAB 1)

UNated mpy of apdicant's PeIsonal History Statement (PHS) vrilh recentphotograph duly notarize 0AB 'l)

original licenses to be lenfled (IAB 2)

Original S@id Bank Receipl (LBP)- Php 2,500.d, OAB 2)

Photmpy of Purdlase/s Ucense of he compaly GAg 2)

3. tr Cenification from the emdoyer/company (IAB 3)

tr Cerlficate of being capable of handling explocives trom licensed mining

engineer (if applicant is not a licensed mining engin€eo 0AB 3)

0 Summary of Consumplion^vithdrarral Repod or Notaized Arfidavil of no

consumption^vi$drawal OA83)d D Endorsefl€nt lrun ROPD & PD/CD (for Prov'lApplicart) (IAB {)

D Endo6ement lrun Bureau of Mines (if company is a mining firm) (TAB l)

Note: Pls. 3ubmit requiremer s as indicatod with WHITE TABBINGS

Address Contacl l{osROUTE REMARKS

1. LICENSE AND PERiIIT SECTION, EMD

Receiving Clerk :

Date/Time ReceivedDate/Time Released

Clerk Siqnature

Processor Signature

Chist, License and Pormit Soction

Date/Time Received:

Date/Time Released:


Chiel, License and Permit Sec

2, CHIEF, EXPLOSIVES IIANAGEiiENT DIVISION

JOHN C BULALACAOPolice Chief lnspector

Chief, EMD

3, AC, FEO

ABAD H OSITPolice Senior SupedntendentAC, FEO

4. C, FEO

Date/Time Received :

Date/Time Released:

ELII,IO FRANCIS O SARONAPolice Chief SuperintendentC, FEO

F-CSGFEOE 0{68-2011

l*lh"r .

Processing SectionDate/Time Received: _Date/Time Released: _

DatdTime Received: _Date/Time Released:

Date/Time Received: _Date/Time Released:

EXPLOSIUS MANAGEMENIJIVISIONPermit to Export Explosives/Explosive lngredients and/or Controlled Chemicals

MANUFACTURER/DEALERr. n Letter request (LR) signed by the authorized representative

lndicating, among others, the explosives/explosive ingredients Note; Since the signatory is an authorizedand/or controlled chemical/s to be exoorted, purity/grade (for representative, he must attach to the LR a certifiedcontrolled chemicals only). true copy of his valid company lD and Board of

z. o Photocopy of License (Manufacturer's or Dealer's License) Director,s Resolution (for corporations)/Specialr. o Original Letter of lntent and End-Use/s Certificate of power of Attomey (for partnerships and soleConsignee proprietorships), as proot of his authority to transacto C,ertification from the consignee that the items will not be on behalf of said eniity. (No alterations by any

exprted to a third party country / original person except the signatory himself, on the LR shallbe allowed).

Lateornon-submissionof@andotherreportorialrequirementswillautomaticallyresult in the disapproval of the application and the imposition of sanctions pursuant to Sections 4E and 4F of R.A. No. 9516

Applicant (Company)

Address:

Contact Pelaon:

Contact No:

RECEIVER/VERIFIER

Signature above printed name:

Chief, Llcenso and Pormit Soction

Received Date: _ 2015Released Date:_ 2015

Time: _ 1Y7PYTime: _ AIi/PM

SOLEDAD E ARCISO

Police Chief InspectorRecommsnd Approval of ltlovement: Chief EilD

Received Date 2015 Time Ai,r/Pi,l

Released Date: 2015 Time: AM/PM


MoYgmsnt : Chief FEO

Received Date 2015 Time

Time

AM/PM

AI\,i/PMReleased Date: _ 2015

ELITIO FRANCIS O SARONAPollce Chief

Recsi\rod Dats: _ 2015 f im6: _ AM/PM

Releasod Date:_@ Tirne: _Aii/PM

EXPLOSIUS MANAGEMENTJIVISIONPermit to lmport Explosives/Explosive lngredients and/or Controlled Chemicals

o MANUFACTURER o DEALER o PURGHASER veuorry:lyceroity

1.n

2.tr

tr3.tr

Letter request (LR) signed by the authorizedrepresenlative indicating, among others, theexplosives/explosive ingredients and/or controlcnemrcaus to oe f, oaseo on slorage capacrtyversus slock on hand and purity/grade.

Special Bank Receipt (Land Bank of hePhilippines LBP)- Php 6,000.00Photocopy of License

lnspection Reports (Certification of lnspection ofMagazine/Storage Facility, Magazine/Storage Facility

lnspection Checklist, Summary of lnventory ofexplosives/explosive ingredienUs and/or controlled

chemical/s, lnventory of explosives/explosiveingrcdienUs and/or controlled chemical/s, Security

Survey) by the PD/CD (for Prov'l Applicant) and l&E,

FEO (for NCR Applicant)

4. tr Endorsement from PD/CD (for Prov'l applicants only)

D Notarized Latest Monthly Reporl and 12 monthsConsumption Report

Note: Since the signatory is an authorized representative,he musl attach to the LR a certified true copy of his validmmpany lD and Board of Directo/s Resolution (for

mrporations)/Special Power of Aftomey (for partnerships

and sole proprietorships), as proof of his authority to

transact on behalf of said entity. (No alterations by anyperson except the signatory himself, on he LR shall beallowed),

Reminder: Late or non-submission of monthlvconsumotlon rcpo s and other reportorialrequirements will automatically result in thedisapproval of the application and the imposition ofsanctions pursuant to Sections 4E and 4F of R.A. No.9516.

Contact PeBon:

Contact No:

Applicant (Company)

Address:

RECEIVER/VERIFIER

Received Date: 2015 Time:

Time:

AM/PM

Ai//PMReleased Date: _ 2015


Chief, Liconse and Permit Section

Received DateReleased Date

20152015

TimeTime

AM/PMA[,VPM

SOLEOAO E ARCISOPolico Chief lnspector

Chiof, EMo

lime: _ 11,1PY

Time: AM/PM

JOHN C BULALACAOPolico Senior Superintendent


Received Dato: _ 2015


Time:

Time:

AI\,I/PM

AM/PM

ELITIO FRANCIS O SARONAPolice Chief Superintendent

Approved: D, CSG

Received Date: _ 2015


lime: _ 1g7Pg

Time: AM/PM

ELi'ER R SORIA

Police Director

Received Dale: _ 2015

Rdessed Date: _ 2015

EXPLOSI\.-S MANAG EME NTJIVIS IONPermit to Purchase/Transfer and Move Explosives/Explosive lngredients and/or

Controlled Chemicals vALtDtw:fo MANUFACTURER O DEALER O PURCHASER

'1. o Lethr request (LR) signed by the auhorized representative For Blasting Contractor:

indicating, among o$ers, he explosivedexplosive ingredienb and/or tr Blastng Sciemecontrolled demicaus to be purchased/tansfer, based on stock on hand tr Agreement or @nbacl of he proiecl W duration.

and purity/grade. tr Certification from PD/CD in the construction/establishment of an

2. tr Photocopy of license issuing magazine where the project is located.

tr OriginalSpecial Bank Receipt (LBP)- Php 1,500.00 tr Environmental Compliance Cedfcate (ECC)from DENR.

3. tr Notarized Latest Monhly Repod tr Endorsement from BMGS (Mining & Quanying)

tr Previous PPME and oelivery Receipt (photocopy) tr Endorsement from DOE (Oil & Geohermal Exploratjon)

tr Endorsement from PD tr Endorsement from PCG (Salvaging)

D EndoBement ftom FPA (Ferlilizer Formulatoo

Reminder Late or non-submission of @tl_gqEffi|IJlpg! and tr Endorsement from DPWH (Road Construction, etc.)

oher reportorial requirements will automatically result in the disapproval of 0 Endorsement from City Enginee/s Office (development ofhe apdllation and he imposition of sanctions pursuant to Seclions 4E and suMivision)4F ofR.A. No.9516 tr Endorsement from oher govemment agencies

Note: Since the signatory is an authorized represenlative, he must attach

to the LR a certified true copy of his valid company lD and Board ofDirector's Resolutjon (for corporations)/Special Power of Attomey (tdpartnerships and sole proprietorships), as proof of his auhority totransact on behalf of said entity. (No alterations by any person except

the signatory himself, on the LR shall be allowed).

Applicant (Company)

Addr$s:

RECEIVERiVERIFIER

2015

m15

Time:

Time:

AI\,UPM

AM/PM


Chief, License and Permit Section

2015

2015

Time:

Time:

AM/PM

AM/PM


Chief, EIIID

Recaived Date:

Released Date:

2015

2015

Time

Time

AM/PM

AIUPM



Recoived Date:

Released Date:

2015

2015

Time:

Time:

AM/PM

AM/PM

EL]TO FRAI{CIS O SARONAPolice Chief Superintendent

F-CSGFEOE D{130.2016

Contact Person: _Contacl Nos: _

Received Date:

Rel€ased oatel

Received Date:

Relsased Date:

EXPLOSITJS MANAG EM E N-JIVIS IONPermit to Unload Explosives/Explosive Ingredients and/or Controlled Chemicals

from the Vessels/Aircrafts and Transport to DestinationMANU FACTURER/DEALER/PURCHASER

l. E Letter request (LR) signed by the authorized representativeindicating, among others, lhe explosives/explosive ingredientsand/or controlled chemicaus to be g4lgAdgd, based on

storage capecity versus slock on hand and purity/grade.2. tr Photocopy of License (IA8 2)

O Original Special Bank Receipt (Land Bank of the Philippines -Php 0.10 per kilogram; Php 0.10 per liter (Amounts iscomputed depending on quantitytuolume of incoming items.)(rAB 2)

tr PNP Form No. 6 - Application to Unload Explosives from theVessels/Aircraffs and Transport to Oeslination (IAB 2)

3. D Packing Listtr Bill of Lading (for sea freight)D AiMay Bill (for air freight only)E Proforma lnvoice (for air freight only)

Applicant (Company)

Address:

Note: Since the signatory is an authorizedrepresentative, he must atach to the LR a certified truecopy of his valid company lD and Board of Directo/sResolution (for corporations)/Special Power of Attorney (forpartnerships and sole proprietorships), as proof of hisauthority to transact on behatf of said entity. (No alterationsby any person except the signatory himself, on the LR shallbe allowed).

Contact Person:

Contact No:

Reminder: Late or non-submission of mooorly aolrarpndoo ltoollr and other reportorial requirements willautomatically result in the disapproval of the application and the imposation of sanctions pursuant to Sections 4E and 4F ofR.A. No. 9516

RECEIVER/VERIFIER

Signature above printed name:

Chief, Licenso end Permit Soction

Received Date: _ m15Released Date: _ 20'15

Tine: _ IYPYTime: AI\,|/PM


Recommend Approval of lilovomont: Chiet El[D

Received Date: _ 2015 Time: _ AM/PM

Released Date: _ 2015 Time: _ AM/PM


ilovem6nt : Chief FEO

Roceived Dat6: _ 2015


Received Date:_ 2015 Tim6:_ AIU/PM

Released oate:_ 2015 Time:_ 1g7PY

Time: _ 1g7PY

Time: _ 1g1PY

ELIIIO FRANCIS O SARONAPolice Chief Superintendent

EXPLOSIL...S MANAG EME NT.JIVISIONSpecial Permit to Purchase/Transfer and Move Explosives/Explosive lngredients

and/or Controlled Chemicalso PURCHASER vALlDlw:I

'1. El Letter request (LR) signed by the authorized representativeindicating, among others, the explosives,/explosiveingredients and/or controlled chemicays to be@]@!@!9@!, purity/grade

2. B Original Special Bank Receipt (LBP) - Php l,5m.0Otr PNP FORM 64

3. tr lf Corporation or Partnership, SEC Registrationtr lf Single Propietorship, DTI Rogistration0 Business Permit

4. tr Original NBI Clearance (Purpose: for PNP Requirement,trl Busimssy'Other requiremant)

Applicant (Company)

Address:

Contact Per8on:

Contact No:

RECEIVER/VERIFIER

Received Date m15 TinE:

-

AM/PI,

Tira: _ Ai Pl,tRdeas€d Date:

-

201 5

Siqnature above orinled name

Chlet Liccnse rnd Pomlt Sec{on

Received Date:

-

201 5

Rdeassd Dale:

-

2015

SOLEDAO E ARCISOPolice Chief lnsp€clor

Chiet, EilD

Received Dale: 2015 Tirne: _ Ati4/PM

Time: _ Ai,UPMRel€as€d Date:

-

201 5

JOHI{ C BULALACAOPolice Seniol Superinlendenl

Recommend App]oval: Chief, FEO

R€ceived oate: _ 2015

Rd€ased Date: _ 2015

Tirne:

-

Air/PM

Tirne: AM/PM

EL O FRAI{CIS O SAROIIAPolice Chief Superint€ndent

F-CSGFEOE D-Ol 30-201 5

Note; Since the signatory is an aulhor2ed rapr€sentiative, h€musl attach to the LR a cartifed true copy of his vglid company lDand Board of Directods Resolution (for corporations)/SpecialPower of Attomey (for partnerships and sole proprietorships), asproof of his authority to transacl on behalf of said anttty. (Noalterations by any person excepl the signalory himself, on the LRshall be allowed).

Tirne: _ AM/PM

Time:-AIUPM

list of requirements for regular application

Documents