SBFZ ENVIRONMENTAL IMPORTATION CLEARANCE

PART 1. (Pls. do not leave any portion blank. Write N.A. if not applicable)

A. IMPORTER INFORMATION:

1. Name of Importer______

2. Address______

3. Contact Person______4. Telephone No______5. Fax no.______

B. SHIPPER INFORMATION (ORfor IMPORTATION OF USED ELECTRONICS OR OTHER RECYCLABLE MATERIALS AS STIPULATED IN RA 6969, THE WASTE GENERATOR):

6. Shipper Name(Waste Generator () ______

7. Facility Address______

8. Volume of Material Imported______9. Types of Packaging______

10. Intended Carriers______

11. Mode of Shipment AIR SEA 12. Port of Entry______13. Expected Date of Arrival______

 A. FOR RECYCLABLEMATERIALS/USED GOODS, e.g., used electronics and electrical equipment, etc.

(pls. describe) ____________

No Importation Clearance (IC) from DENR is required for:

Imported items that are for 100% export/re-export.

Imported materials that are being declared or certified herewith as to be delivered/used to the following RECYCLING FACILITY within the Subic Bay

Freeport Zone (SBFZ) only

1. Facility Name______Contact Person______

2. Address______Telephone/Mobile Phone No. ______

An Importation Clearance (IC) from DENR-EMB is required, if item/s is/are to be sold or used or permanently brought outside the SBFZ area and into customs territory, but within the Phils. (Items that are temporarily brought outside the SBFZ area for additional processes but to be brought back again into SBFZ for final export/re-export, do not require an IC) IC attached?  YES  NO

 B. FOR CHEMICAL/CHEMICAL SUBSTANCE, e.g., pure chemicals such as sulfuric acid, nitric acid, cyanide, etc.

(specify)______

The appropriate permit or clearance attached -- SEE GENERAL NOTE BELOW FOR OTHER REQUIRED ATTACHMENTS

--.Importation Clearance(IC) from DENR-EMB ?  YES  NO

-- Permit or clearance from other government agency  YES  NO, specify ______

NOTE: An IC is filed at least thirty (30) days prior to the import activity and is done on a per chemical and per shipment basis. Compliance to corresponding permit and clearance requirements are advised for chemicals/chemical substances covered by the Revised PCL or CCO . (Verify if the applied chemical components are in the PICCS or in the Revised PCL or with a CCO, by a review of the Material Safety Data Sheet or MSDS of the applied chemical component to get the Chemical Abstract Services (CAS) No.for verification purposes.)

C. FOR IMPORTED WOOD OR LUMBER

 Endorsement to DENR CENROfrom Ecology Center that a locator is allowed by SBMA to engage in import of wood or lumber based on SBMA-approved business activity, as required by DENR CENRO.  YES  NO. Other required document/s (specify) ______

D. FOR OTHER GOVERNMENT-REGULATED IMPORTED MATERIALS

(specify/describe)______

GENERAL NOTE: The issuance of this clearance does not preclude other requirements from other Regulatory agencies like the Fertilizer and Pesticides Authority (FPA), Phil. Drug and Enforcement Agency (PDEA), Phil. National Police (PNP), Bureau of Food and Drug (BFAD), Dept. of Health (DOH), etc.

1. Applicant shall attach to this Clearance Request all import documents relative to the import activity, including other permits, clearances and certificationsrequired by other laws, as appropriate and as regulated by other concerned government agencies, authorIties or offices.

2. All residual wastes generated in the import activity shall be disposed at the Olongapo Sanitary Landfill, in accordance with RA 9003 and SBMA

Waste Management Guidelines.

DECLARATION: I hereby declare that all the above information provided above are true and correct.

F. Applicant’s Signature______Designation/PositionTitle ______

Printed Name (Pls.write legibly)______Date ______

ADDITIONAL NOTE: As stipulated under Republic Act No. 7227, imported goods/items transported outside the Freeport fall under customs territory and become subject to all duties and taxes and permit or clearance requirements from other government agencies.

PART 2. (To be filled up by SBMA Ecology Center only)

______

Manager, Ecology Center

Date Approved ______

Subic Bay Metropolitan Authority

ECOLOGY CENTER

Regulatory Bldg. Rizal Highway corner Labitan St., Subic Bay Freeport Zone, 2222 Philippines

 Tel: +6347 252.4435/4416Fax: +6347 252.4157