Verified Application Form 1 LTFRB

REPUBLIC OF THE PHILIPPINES Department Dep artment of Transportatio Transportation n and Communications Communications LAND TRANSPORTATIO TRANSP ORTATION N FRANCHISING FRANCH ISING AND REGULATORY BOARD East Ea st Avenue, Quezon City

 Application for the the Issuance ssuance of a Certificate of Public Convenience To Operate a TNV Service

CASE NO.______ NO.________________ __________  _______________  _______ ________________ ______________ ___________, _____,  Applicant/s.  Applicant/s. X-----------------------------------------------------X

APPLICATION COMES NOW,  Applicant/s  Applicant/s and unto unto this this respectfully allege/s:

Honorable Honorable Board

most

That applicant/s is/are a Filipino citizen/s/ corporation existing and duly organized under Philippine Laws and with business address at  _______________  _______ _______________ _______________ _______________________ __________________________________; ___________________; That applicant/s hereby apply/ies for the issuance of a Certificate of Public convenience to operate a TNV Service for the transportation of passengers and freight within/on the route Metro Manila to any part in Luzon with the use of  ________  _______ _ (__) unit unit/s, /s, to wit:

MAKE

MOTOR MOTOR NO

CHASSIS CHAS SIS NO

PLATE PLA TE NO

That applicant/s is/are financially capable to operate and maintain the service being applied app lied for; That as a transition period for this type of service coupled with the presentation of a copy of the passenger insurance policy, applicant/s shall be issued a Provisional Authority (PA) pursuant to LTFRB Memorandum Circular No. 2015-017; That applicant/s will comply with all the requirements of this Honorable Board and will abide with the existing LTFRB Rules and Regulations, the Public Service Act, and other pertinent laws/policies; and That with the consideration and approval of this application with PA, public necessity necessi ty and and convenience convenience will be promoted pro moted in a suitable manner. WHEREFORE, it is most respectfully prayed unto this Honorable Board that this Application with PA for the issuance of a Certificate of Public Convenience (CPC) to operate a TNV Service be accepted and considered. 1

Thereafter, a Provisional Authority  and Notice of Hearing be issued as well as the decision granting the applicant/s the CPC.  _______________________ Place and Date

 ___________________________  Applicant/s WAIVER I/We, (name of applicant/s), hereby grant/s authority to LTFRB, to verify the authenticity of all the documents herein submitted together with this  Application with PA from both government and private sources.

 ___________________________  Applicant/s

VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING I/We _____________________________, Filipino/s and with business address at _______________________________________________________, after having been duly sworn to in accordance with law hereby depose and say that: 1. 2. 3. 4. 5. 6.

I/we am/are the applicant/s in the above-entitled case; I/We have caused the preparation of the foregoing Application with PA; I/We have read the contents thereof and the same are true to the best of my/our knowledge and belief; I/We have not commenced any other action or proceeding involving the same issues in any other LTFRB Office; To the best of my/our knowledge, no such other application, petition or pleading is pending therein; If I/We learn of the same or similar application, petition, or pleading has been filed or is pending, I/We shall report of such fact within five days therefrom to this Honorable Board.

 ___________________________  Applicant/s

SUBSCRIBED AND SWORN to before me this ___ day __________ at  ______________________________. Affiant/s exhibited to me his/their /its Government Issued ID ____________________________________ issued at  ______________ on ________________________. Doc. No._____; Book No._____; Page No._____; Series of _____.

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