REPUBLIC OF THE PHILIPPINES

Department of Transportation and Communications

LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
Regional Office 9
City Sports Complex, JS Alano St., Pagadian City

_______________________________, CASE NO. _______________________

Petitioner/s
x ------------------------------------------------------------------------- x
RE: SPECIAL PERMIT FOR OUT OF LINE OPERATION

PETITION

COMES NOW, Petitioner/s and unto this Honorable Board most respectfully state/s that:

That Petitioner/s is/are grantee of Certificate of Public Convenience to operate an

airconditioned/ordinary PUB service on the line: ____________________________________
via
______________________________________________________________________________
_________.

That, in view of the expected increase in the volume of passengers who will commute to
different provinces due to
___________________________________________________________________, Petitioner/s
hereby ask/s for authority to operate under Special Permit with said service on the line:
______________________________________________________________________________
______ vice versa, from _____________________________________________ to
_______________________________ with the use of _______________________ ( ) unit/s, to
wit:

MAKE MOTOR NO. CHASSIS NO. PLATE NO.

That the number of units being applied for this authority does not exceed 25% of the total
number of authorized units granted to the Operator on the specified route/case number.

That public service and convenience will be served most in a proper and suitable manner
with the approval of this petition;

That the Petitioner/s hereby abide/s to comply with the requirements and regulations of
this Honorable Board relevant to this Petition.

WHEREFORE, it is respectfully prayed that after due consideration, the foregoing

petition be approved.

________________________________
Petitioner/s

WAIVER

I, (name of petitioner), hereby grants authority to LTFRB, to verify the authenticity of all
the documents herein submitted together with this petition from both government and private
sources.
________________________________
Petitioner/s
 VERIFICATION

I/ WE ____________________________________ Filipino and with business address at

___________________________________________________ after having been duly sworn to
in accordance with law hereby depose and say: That I/WE am/are the petitioner/s in the above-
entitled case; That I/WE have caused the preparation of the foregoing application and have read
the contents thereof; and the same are true to the best of my knowledge and belief.

________________________________
Petitioner/s

SUBSCRIBED AND SWORN to before me this ________ day of _______________ at

____________________ Affiant exhibited to me his _______________________ issued at
____________________ on __________________________.

Doc No. : _________

Book No. : ________
Page No : _________
Series of : _________