ANNEX B

Republic of the Philippines

Palawan Council for Sustainable Development

APPLICATION FOR: WILDLIFE SPECIAL USE PERMIT (WSUP)

(Submit in duplicate)

Attach
2x2 photo

(Date)

NELSON P. DEVANADERA
The Executive Director
Palawan Council for Sustainable Development Staff

Sir:
In accordance with R.A. 9147 otherwise known as the "Wildlife Resources
Conservation and Protection Act", with which I shall familiarize myself and to which
compliance of same is hereby promised,
1. I, ______________________________ have the honor to apply for a Wildlife Special Permit.
(Name)

2. I am _____________ years of age, citizen of _______________________________ by birth

(if by naturalization, submit papers for verfication)

January
01
Date of birth: _________________________
Place: _________________________________
Residence: _____________________________________ Tel. No.: _____________________
Business Adress: ________________________________ Tel. No.: _____________________
3. I am single / married and the name of my spouse/wife is _____________________________
4. I am member/not a member of a sportsmen and/or game club and/or scientific or
conservation society. State name of organizations, if member.
____________________________________________________________________________
5. I intend to collect the following economically important wildlife species for direct
trade/commercial purposes:
Kind/Species
No.
Collection Sites/Methods of Collection
______________________

_________

____________________________________

______________________

_________

____________________________________

______________________

_________

____________________________________

______________________

_________

____________________________________

6. Wildlife species to be collected under this permit shall be taken by the following authorized
collectors:
Names
Address
____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

7. I understand that the information stated in this application are true and correct and any
omission of facts therein shall cause the disapproval of this application and/or cancellation of
the permit that may be issued to me.
8. I understand that the filing of this application conveys no right to take, collect or possess
any wildlife until a permit is issued to me by the PCSD.
9. The application fee in the amount of __________________________ made payable to the
PCSDS with Official Receipt No. is herewith enclosed. Non-approval or non-isuance of the
permit does not entitle me to a refund of the fee.

(Signature of applicant)
TIN: ______________________________

(Address)

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___________________________________
CITY OF ________________________________________
SUBSCRIBED AND SWORN to before me this ___________ day of 20_____, appicant
exhibiting to me his/her Community Tax Certificate No.
________________________ issued at ___________________________________,
on ________________ 20______.

(Office authorized to administer oath)

Printed Name and Signature

(Official designation)