Republic of the Philippines

Department of Environment and Natural Resources

COMMUNITY ENVIRONMENT AND NATURAL RESOURCES OFFICE
DENR RXII-A, Brgy. San Vicente, Banga, South Cotabato
Telefax No. (083) 239-1203

SUBJECT:
Survey Authority for a tract
of public land located at:
______________________
______________________
Survey Authority No. ______________ ___________________
Date
Engr. ________________________
_____________________________
_____________________________

Sir:

Pursuant to DENR Administrative Order No. 38 and upon evaluation of the request of
___________________________________________ claimant of the above-described tract of
public land, to avail of your services, authority is hereby granted to you to execute the survey
thereof subject to the relevant provisions of the Manual for Land Surveys in the Philippines as
amended and to the conditions stated at the back hereof.

Violation of any of the aforesaid conditions shall invalidate this authority, and damages that
may result therefrom shall be your sole liability and professional responsibility.

Very truly yours,

For and by the Authority of

the Secretary of DENR:

_______________________
CENR Officer

Conditions accepted: _______________ 20 _______

(4) _______________________________
(Signature/Name of GE)

__________________________________
(License No. )
---------------------------------------------------------------------------------------------------------------------
Above Stated: Issuance of Survey Authority
recommended:

(1) __________________________________ (2) ________________________

(Signature/Name of Claimant) (Address) (Signature/Name)

_________________________________ _______________________
(Signature/Name of Claimant) (Address) (Position or Designation)

Ref. ____________________________________ Ref. Insp/Invest. Report

Cad. Cost of P________________________ paid Date: _________________________
Under O.R. No. __________________________ dated _________________________

Note: For this Survey Authority to be valid, the four (4) required signature must be present.

Lands Form