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)