Downloadable Forms at: www.dar.gov.

ph free of charge

CARPER LAD Form No. 9

(New)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
MANIFESTATION TO APPLY/PETITION FOR EXCLUSION/EXEMPTION OR
TO FILE PROTEST OF CARP COVERAGE

___________________
Date
The Honorable Secretary
Department of Agrarian Reform
Diliman, Quezon City

Thru: _________________________
Provincial Agrarian Reform Officer II

Sir:

May I/We manifest our intention to apply/petition for EXCLUSION/EXEMPTION or FILE PROTEST on
CARP Coverage for the following parcel of land subject of Notice of Coverage (NOC) dated
____________________:

Title No. (if any): _____________________________________________________

Tax Declaration: _____________________________________________________
Name of Land Owner/s: (Family Name, First Name, Middle Name)
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Area in hectares: _____________________________________________________
Location: (Municipality, Barangay)
_____________________________________________________

In support of this application, I/we will submit the necessary information and records/documents
required under DAR pertinent guidelines on the matter within thirty (30) days from the date of the
NOC for protest on coverage and sixty (60) days from the date of NOC for exclusion/exemption. It is
understood that my failure to submit the documentary requirements within the prescribed period
shall be construed as my/our waiver thereat.

Very truly yours,

Name of Landowner/s Signature Date

CARPER LAD Form No. 9/Page 1 of 2

 Downloadable Forms at: www.dar.gov.ph free of charge

Authorized Representative
Address
(Family Name, First Name, (MM/DD/YYYY)
Middle Initial)

Copy Distribution:
Original - CF
Duplicate Original – DARMO
Triplicate - DARPO

CARPER LAD Form No. 9/Page 2 of 2