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Republic of the Philippines

Department of Transportation
LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
Regional Office ____,

Juan Pedro,
Applicant. CASE NO. ______

Application for Extension of Validity


Of Certificate of Public Convenience
With Dropping and Substitution of
Unit, Provisional Authority and Upgrading
and Unit from Non-air-con to Air-con
operate a PULS Service.

APPLICATION

COMES NOW, applicant in the above-entitled case and unto this Honorable
Board most respectfully states:

That applicant is a grantee of a Certificate of Public Convenience to operate a


PUB on the route: _______ and Vice Versa which expired on January 28, 2019 with the
use of One (1) unit described as follows:

MAKE MOTOR NO. CHASSIS NO. PLATE NO.


_______ _____________ ______________ ___________

That applicant request to extend the validity of the said Certificate of Public
Convenience for a period of which this Honorable Board may deem necessary to
grant:

That applicant further requests authority from the Honorable Board to drop
his unit described-above and substitute it with another unit more particularly
described hereunder:

MAKE MOTOR NO. CHASSIS NO. PLATE NO.


_______ _____________ ______________ ___________

That applicant also requests to the Honorable Board that pending approval of
this application a Provisional Authority be granted:

That applicant further request to the Honorable Board to upgrade his existing
unit from Non-air-con tow Air-con:

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That applicant is a Filipino citizen, financially capable and legally qualified to
continue the operation of PUB Service:

That the applicant will continue to comply with the rules and regulations,
orders, resolutions under circulars issued by the Honorable Board, and those which
may be issued and promulgated from time to time pertaining to the operation of the
above service:

That public service and convenience will be served most in a proper and
suitable manner with the approval of this application.

PRAYER

WHEREFORE, it is respectfully prayed that after due consideration, the


foregoing application be approved.

______ City, Philippines. ______, 2019

JUAN PEDRO
Applicant

WAIVER

I, Juan Pedro, hereby grants authority to LTFRB to verify the authenticity of


all the documents herein submitted together with this application from both
government and private sources.

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VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I, JUAN PEDRO, Filipino, and with address at _________, after having been duly
sworn to in accordance with law hereby depose and say that:

1. I am the applicant in the above-entitled case:


2. I have caused the preparation of the foregoing application:
3. I have read the content thereof and the same are true to the best of my
knowledge and belief:
4. I have not commenced any other action or proceeding involving the same
issues in any other LTFRB Office:
5. To the best of my knowledge no such other application, petition, or
pleading is pending therein:
6. If I learn of the same or similar application, petition, or pleading has been
filed or is pending. I shall report of such fact within five (5) days therefrom
to this Honorable Board.

JUAN PEDRO
Applicant

SUBSCRIBED AND SWORN to before me this ______ day of


_________________________ at _____________________________________ Philippines, affiant
exhibited to me his ______________________________________________________________________.

Doc. No. __________________.


Page No. _________________.
Book No. _________________.
Series of 2019.

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