Annex C

APPLICATION FOR CERTIFICATE OF TAX CLEARANCE

(Corporation)

(Name of Authorized Representative)

I, ________________________________, with Taxpayer Identification No. (TIN)
_______________________, of legal age, residing at _____________________________
with telephone/cellular phone no. ____________________ and presently connected with
(Position/Designation)
________________________________ as _________________________ duly sworn to in
accordance with law hereby depose and state:

(Name of Operator/Corporate Name)

1. That ____________________________ with TIN ____________________ is a
corporation/company duly recognized and existing under and by virtue of the Laws of
the Philippines with office located at _______________________________________
is the owner of Certificate of Public Convenience No. ___________________ dated
_______________;
2. That (Name of Operator/Corporate Name)
________________________________________________________ is
registered with BIR under Certificate of Registration No. _____________________
issued at Revenue District Office No. __________ on
________________________________;
3. That this Application for Certificate of Tax Clearance is being submitted in order to
secure a Tax Clearance Certificate in connection with the abovementioned companys
Application for the Approval of Sale and Transfer of the abovementioned CPC with
the Land Transportation Franchising and Regulatory Board (LTFRB) pursuant to
Department Order No. 2010-34 issued by the Department of Transportation and
Communications (DOTC).

__________________________
Signature Over Printed Name of
Authorized Representative

SUBSCRIBED AND SWORN to before me this ________ day of

__________________, 2012 in ___________________________ applicant exhibited to me
his/her Community Tax Certificate No. ______________________ issued at
_________________________ on ___________________________.

Notary Public
Until __________________
PTR No. _______________
Issued at _______________
On ____________________
Doc. No. __________
Page No. __________
Book No. __________
Series of __________

Affix P 15.00
Documentary
Stamp Tax