MGB Form 29-17 (Series of 2000)
MGB Form 29-17 (Series of 2000)
Republic of the Philippines
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Mineral Economics Information and Publication Division
North Avenue, Diliman, Quezon City
ANNUAL REPORT OF SMALL SCALE MINING PERMITTEE
For the Report Year ____________
NAME OF COMPANY/LICENSE/PERMITTEE
ADDRESS (Mailing address):
PART 1 - MINE INFORMATION
SITE NAME REGION PROVINCE MUNICIPALITY
Major Product (Enter only one major product per site) Date of First Operation Change
Year: Month: Day:
MINING METHODS USED: (Enter only one mining method per block) MILLING METHODS USED: (Enter only one milling method per block)
1. 1.
2. 2.
3. 3.
Telephone Number: (Write only one telephone number and one local number)
Direct Line: Local No.: Fax No.: E-mail Address:
NAME OF MANAGING OFFICIAL POSITION
PART 2 - TOTAL PRODUCTION
UNIT GROSS QUANTITY GROSS VALUE (000) AVERAGE GRADE
A. PRIMARY
P
B. BY-PRODUCTS
P
PART 3 - TOTAL EXPORT/LOCAL SALE
COUNTRY OF GROSS QTY GROSS VALUE AVERAGE
DESTINATION (Specify Unit Used) Pesos (000) Dollars (000) GRADE
A. PRIMARY
P $
B. BY-PRODUCTS
P $
PART 4 - EMPLOYMENT
Report number of persons who worked at the MINESITE during the payroll ending nearest 15th of each month indicated.
TYPE OF EMPLOYMENT Jan - Mar Apr - Jun Jul - Sept Oct - Dec TOTAL
1. REGULARLY-PAID EMPLOYEES
1.1 Production Workers
a. Skilled
b. Laborer
1.2 Admin. Employees
1.3 Supervisory Employees
2. IRREGULARLY-PAID EMPLOYEES
2.1 Working Proprietors
2.2 Family Workers
3. OTHERS (not included above)
TOTAL (1 to 3)
Jan - Mar Apr - Jun Jul - Sept Oct - Dec TOTAL
MAN-HOURS WORKED BY PRODUCTION WORKERS
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MGB Form 29-17 (Series of 2000)
PART 5 - CAPITAL INVESTMENT
BOOK VALUE, As End of Report Year _____________
TYPE OF CAPITAL INVESTMENTS (Value in Thousand Pesos)
(for Equipment/machineries, infrastructures)
1. Lands
2. Mining Rights
3. Exploration and Development
4. Mine & Mill Equipment/Machineries
5. Support Service Equipment/Machineries
6. Building and Civil Works
7. Office Equipment
8. Working Capital
9. Others (specify)
T O T A L (1 to 9)
PART 6 - PRODUCTION COST: COST OF USED MATERIALS AND SUPPLIES
Report the value of materials and supplies used during the report year. Include industrial and non-industrial costs incurred by this site in its operations. Allocate accounts to
headiing. Value in thousand pesos.
HAULING,
ADMINIS-
ITEMS Volume Unit of Measure MINING MILLING HANDLING & TOTAL
TRATION
STORAGE
1. Grease and Lubricants (liter) P P P P P
2. Chemicals
3. Explosives
4. Spare Parts
5. Containers and Packing Materials
6. Lumber
7. Steel Balls
8. Non-Durable Tools
9. Others Not Included Above
TOTAL (1 to 9) P P P P P
PART 7 - PRODUCTION COST: COST OF LABOR
Report number of persons who worked in or for this company, their basic salaries and wages, overtime pay and benefits for work done by regularly paid employees within the
report year, paid in cash and in kind prior to all deductions such as witholding tax, group insurance, union fees, etc. Value in thousand pesos.
Number of EXTRA EXTRA
TYPE OF REGULARLY-PAID SALARIES & OVERTIME
Regularly Paid SSS/GSIS BENEFITS BENEFITS TOTAL
EMPLOYEES WAGES PAY
Employees PAID IN CASH PAID IN KIND
1. MINING P P P P P P
a. Skilled
b. Laborer
2. MILLING P P P P P P
a. Skilled
b. Laborer
3. Hauling, Handling & Storage P P P P P P
a. Skilled
b. Laborer
4. Administrative Workers
TOTAL (1 to 4) P P P P P P
PART 8 - PRODUCTION COSTS: COST OF FUELS AND UTILITIES
Report the value of fuel and utilities consumed during the report year. Allocate accounts according to heading. Value in thousand pesos.
1. COST OF FUELS (indicate if gas, gasoline, diesel oil, bunker oil, coal, etc)
Hauling,
Quantity Unit of Measure Mining Milling Handling & Administration Total
Storage
(liter) P P P P P
TOTAL COST OF USED FUELS BY SOURCE P P P P P
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MGB Form 29-17 (Series of 2000)
2. COST OF UTILITIES
Hauling,
Quantity Unit of Measure Mining Milling Handling & Administration Total
Storage
2.1 Water Liter
a. Purchased
b. Generated (If pumped by
above fuels do not include in totals
2.2 Electricity KWH
a. Purchased
b. Generated
b.1 By the above fuels
b.2 By Other Sources
3. Sold
TOTAL (2.1 + 2.2 + 3) P P P P
PART 9 - OPERATING EXPENSES AND OTHER CHARGES
Report the value of expenses of the MINESITE for the report year. Include industrial and non-industrial charges incurred in the operations. Value in thousand pesos.
1. OPERATING EXPENSES
1.1 Marketing Expense
1. Smelter Charges P 4. Assaying & Analysis Charges P
2. Refinery Charges 5. Other Marketing Expenses
3. Freight Charges (Excluding customs duties) SUB-TOTAL (1.1 - 1 TO 5) P
1.2 General & Administrative Expenses
1. Repair & Maintenance of Buildings and 8. Cost of Assets Sold In The Same Condition
equipment (Fees received by Others) as Purchased
2. Insurance Payments (excluding those related 9. Donations and Contributions
to employment)
3. Transportation Expense (outside of production 10. Rentals Expense Outside of Those Paid
and freight charges) Under Taxes
4. Telephone, Telegraph, Postage and Other 11. Royalties Outside of Those Paid Under Taxes
Communication Expenses
5. Legal, Accounting, Auditing & Other 12. Provision for Bad Debts
Professional & Business Services Fees
6. Commission Expense 13. Others Not Included Above (Specify)
7. Cost of Activities such as Construction SUB-TOTAL (1.2 - 1 to 13) P
Contracted and Sub-Contracted by Others
TOTAL OPERATING EXPENSES (1.1 & 1.2) P
2. DEPRECIATION P
3. INTEREST EXPENSES P
4. DEPLETION CHARGES P
5. ENVIRONMENTAL COST P
6. SOCIAL DEVELOPMENT COST P
PART 10 - TAXES PAID (December 31, _________), Value in Thousand Pesos
1. NATIONAL IMPOSITIONS
1.1 Excise Tax on Minerals P 1.6 Documentary Stamp Tax P
1.2 Income Tax 1.7 Other National Taxes (Specify)
1.3 Customs Duties/Fees A.
1.4 Value added Tax B.
1.5 Capital Gains Tax 1.8 Total National Taxes (1.1 to 1.7) P
2. LOCAL IMPOSITIONS
2.1 Real Property Tax P 2.7 Wharfage Fees P
2.2 Local Business Tax 2.8 Sand & Gravel Tax
2.3 Residence Tax 2.9 Permit Fees
2.4 Occupation Tax 2.10 Other Local Taxes (Specify)
2.5 Community Tax
2.6 Registration Fees 2.11 Total Local Taxes (2.1 to 2.10) P
3. WITHHELD TAXES
3.1 W/T on Payroll P 3.6 W/T on Interest Payments P
3.2 W/T on Royalties on Claim-owners/Surface 3.7 W/T on Royalty for Transfer of Technology
Owners
3.3 W/T on /dividends 3.8 Other Withheld Taxes (Specify)
3.4 W/T on Profit Remittance to Mother Company
3.5 W/T on Interest Income 3.9 Total Withheld Taxes (3.1 to 3.8) P
GRAND TOTAL (1.8 + 2.11 + 3.9) P
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MGB Form 29-17 (Series of 2000)
PART 11 - GROSS RECEIPTS
Report the value of sales and other receipts of this site. For goods shipped, inlcude sales and consignments, sales should be reported net of discounts,
allowances and returned goods, FOB mine site.
DESCRIPTION OF RECEIPTS AMOUNT
1. VALUE OF SHIPMENTS OF PRODUCTS PRODUCED, MINED P
2. OTHER RECEIPTS (Specify) P
T O T A L (1 and 2) P
PART 12 - INCOME STATEMENT
1. OPERATION INCOME
(GROSS RECEIPTS Less production Cost plus Operating Expenses plus Depletion Charges plus
Depreciation Charges plus Taxes Paid) P
2. INCOME BEFORE TAX (Operating Income less Interest Expense) P
PART 13 - REPORT ON PROBLEMS ENCOUNTERED
Describe the problems encountered in the mine site with respect to the specified areas listed below
1. RAW MATERIALS, POWER, FUEL
2. POLLUTION CONTROL
3. MACHINERIES AND EQUIPMENT
4. FINANCE AND CREDIT
5. GOVERNMENT POLICIES/REGULATIONS
6. OTHERS
PREPARED BY: OFFICIAL DESIGNATION ADDRESS TELEPHONE NO.
(Signature Over Printed Name)
CERTIFIED BY: OFFICIAL DESIGNATION ADDRESS TELEPHONE NO.
(Signature Over Printed Name)
CERTIFICATION
I hereby certify that all information in this report are complete,true and correct to the best of my knowledge and belief
SIGNATURE OF REPORTING OFFICIAL OFFICIAL POSITION DATE
REPUBLIC OF THE PHILIPPINES)
) S.S.
)
Subscribed and sworn to before me this _______day of ____, 20____, the affiant exhibiting his/her Residence Certificate
No. _______________, issued at ________________, on the _______ day of ______________ 20_____.
DOC NO.
PAGE NO NOTARY PUBLIC
BOOK NO. My Commission Expires on Dec. 31, _________
SERIES OF PTR No. _____________________________
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