LUC FORM NO. 6 DENR Certification No.

________
Series of 2002
(To be filled-up by the DENR)

Republic of the Philippines

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
Office of the Regional Executive Director
Region VII

C E RT I FI CAT I O N

THIS IS TO CERTIFY that the ___________parcel(s) of land situated in

Barangay(s)___________, Municipality of _______________, Province of
_____________________, covering an area of ____________ specifically identified as
follows:

Registered Owner Lot No. OCT/TCT/TD Area Per Title Area Applied
No. (Ha.) for Conversion
(Ha.)

(Please use separate sheet if necessary and attach as annex to this LUC Form)
 ( Please check )
1. Within protected areas under the National Integrated Protected Area System (NIPAS)
Within environmentally critical area (ECA); specify_____________________
Within mossy and virgin forests
Within riverbanks
Within swamp forests and marshlands
None of the above

Further, the proposed project to be undertaken in the area applied for conversion is:
1. Environmentally critical project (ECP); specify:_____________________
Not environmentally critical project (ECP)

NOTE: If the subject properly falls within ECA or the proposed project is an ECP, an
ECC shall be secured and attached to this certification as additional
documentary requirement.

This Certification is issued upon the request of Mr./Ms. __________________

relative to his / her application for land use conversion.

Additional Condition to the issued ECC:

1. Establishment of reforestation using endemic/indigenous species or other carbon sink

programs such as the use of biochar to mitigate greenhouse gas (GHG) emission of
the project in line with the DENR’s thrust for GHG emission reduction programs;

2. The Proponent shall secure all the necessary permits from other pertinent government
agencies but not limited as stated in Annex B, such as the following: DENR-MGB
Area Clearance, Other Lawful Permits (OLP), Tree Cutting Permit (TCP), Building
Permit, FMB Permit, Environmental and Sanitation Permit, PCA Permit, and Disposal
Permit from Capitol; and Environmental and Sanitation Permit; Thus, this ECC
becomes valid only after submission of the above necessary permits to this Office for
the issuance of notice of project implementation prior to any construction activities;

Given this _______ day of ________________, _________.

ENGR. WILLIAM P. CUÑADO

Regional Director

Note:

1. This Certification shall not be considered as development permit.

2. This Certification shall not be construed as an Environmental Compliance Certificate (ECC).