MGBMC2012 02
MGBMC2012 02
MGBMC2012 02
Annex A
____________________
(Date)
PHOTO
(2X 2)
Name:
Surname
First Name
Middle Name
Age:
Date of Birth:
Address:
Contact
Number/s:
E-Mail Address:
Educational Year
School/College/University
Background: Graduated
Primary
Secondary
College
Course
Professional
Regulation
Commission No.
1
Present Employment
Current/Latest Project on
Mineral Land Surveys or
related activities
__________________________
Geodetic Engineer
PTR No. __________________
__________________________
NOTARY PUBLIC
2
Annex B
ORDER
1. Letter-Application;
3
6. Sworn statement stating that the applicant has the capacity to undertake the
mineral land survey and shall abide by the pertinent provisions of DAO No.
2010-21 on the conduct of mineral land surveys; and
7. Five (5) specimen signatures with dry seal markings on a 5 x 8 index card;
1. That the deputation shall have a term of three (3) years effective from the
date of issuance of this Order and terminate on _______________;
a. Has violated any of the terms and conditions of the Order of Survey or
the survey service contract, or has failed to execute the survey and
submit the Survey Returns within the prescribed period;
c. Has violated any pertinent provisions of DAO No. 2010-21 and other
relevant laws, rules and regulations.
SO ORDERED.
_
Regional Director