MANOLO FORTICH WATER DISTRICT NO: 050 mail: mfivd_buk@yahoo.com WATER CONNECTION APPLICATION COMPANY NAME represented by. APPLICANT (CONCESSIONAIRE) t Contact No.: TastName FirstName ‘Middle Name SEX: _ Male Female MARITAL STATUS :__Single _ Married _ Widow/Widower Separated HOME OWNERSHIP —Owner_TenantLessee _ Contractor __ Temporary Occupant HOUSE/BUILDING OWNER ee Tast Name FirstName idle Name (Please specify the name ifthe applicant snot the house building owner) ‘SERVICE CONNECTION ADDRESS: NAME OF SPOUSE Last Name rst Name Middle Name To be filled by MFWD: SERVICE CONNECTION FEE: P OR NO. DATE: TELLER —ee CLASSIFICATION: : ___ Commercial ___ Governmentinstitutional ___ Residential APPLICATION STATUS 7 New _—— Change of Name (Original Registered Name) Meter Brand Size__"® Serial No. : Date Installed Installed byMANOLO FORTICH WATER DISTRICT A. Ditona St., Tankulan, 8703 Manolo Fortich, Bukidnon obik: Hodine = 0917-718-1311 website :mfvedgorplt_ e-mail: mfuel_buk dyudhoncom WATER SERVICE CONTRACT This Contract of Water Servicing is made and entered by and between the MANOLO FORTICH WATER DISTRICT, represented by General Manager, ENGR. ROGELIO K. PANGAN, herein referred as the ‘Distro’, and of legal. «=sage, ~—‘Filipino, —»smaried == to with residence and postal «address at herein referred as the ‘Concessionaire’ WITNESSETH That the “DISTRICT* and the “CONCESSIONAIRE’, in consideration of the Mutual Covenants and Agreements made hereby these presents, enter into Contract of Water Service effective with the following conditions: A. INSTALLATION 4. The DISTRICT shall instal a water service connection to the property of the CONCESSIONAIRE as described in the accomplished application for installation form. Installation will be made only upon approval of the submitted application form by the General Manager and upon payment ofthe required application fee and other charges relative thereto. 2. The water meter should be installed at the designated water service pads/tapping points by the Districts authorized plumbers. All materials after the water meter wil be provided by the concessionaire; labor expenses relative thereto wil be at the concessionaire's expense. a, Distribution lines after the waler meter shall be maintained by the concessionaire and any wastage, damage or leckage not caused by the DISTRICT shall be shouldered by the CONCESSIONAIRE, b. For concessicnaire's whose service line passes through private propertylies, it is the concessionaire's responsibilty to secure written permission from the rightful owner of said property/ies. This written permission shall form part of the requirements for application, ‘Sienature of Applicant B. DISCONNECTION ‘The DISTRICT shall discontinue its water services to a concessionaire in any of the following grounds: 1. Failure to pay on due date, Disconnection notice will be given to concessionaires after due date, Disconnection of service connection due to delinquency will be implemented 48 hours after due date (as amended per BOD Res. No. 34 series of 2018). 2. Any violation of RA 8041, otherwise known as the Water Crisis Act of 1995 as provided in Rule 5, Section 3 and 5.2 of any fraudulent practice in relation tothe use of the water and water system. 3, Noneomplianca to other DISTRICT policies and Board Resolutions pertaining to water services, C. RECONNECTION 4. Disconnected installation due to delinquency and other legal ground for disconnection can be reconnected ‘upon full payment of arrears, reconnection fees and penalty charges. However, reconnection maybe held pending in cases of water shortage or similar situation that will affect majority of the consumers. 2. Request for reconnection of disconnected connection by another person to replace the name of the original registered concessionaire may be granted upon application for change name of the disconnected service connection properly approved and upon settlement of all previous accounts and all other charges of the said registered concessionaire. 3, CONCESSIONAIRE who requested for a voluntary disconnection of his service lines are required to pay the prevailing reconnection fee before reconnection is implemented. 4, The water meter is property of the DISTRICT, hence the concessionaire should protect it from damages and will be required to pay the equivalent amount in case of is loss or damage while in possession. D. RATES AND FEES Classification Installation Fee and Other Charges for New Connection ResidentialiCommercial/industrial P 2,400.00 Note: Rates and fees shall be based on the currents approved schedules and is subject to change with prior notice and upon approval of the MFWD Board of Directors.E, GENERAL POLICIES 4, Payment of bills snall be made only to the DISTRICT’s designated tellers and cashiers. 2. All unpaid bills after due date shall be considered arrears and subjact to 10% penalty charge. 3, The DISTRICT stall provide a water meter to the concessionaire and in tum the concessionaire should protect it from any damage and shall be required to pay the equivalent amount in case of its loss or damage while in possession, 4, Should an issued water meter be destroyed or becomes unserviceable for any reason or another, the CONCESSIONAIRE should immediately report ito the DISTRICT for appropriate action. In case of uncertainty of consumption, the average of the highest three (3) months previous consumptions for a period of one year shall be the basis of subsequent bill consumption. 5, The CONCESSIONAIRE shall allow authorized personnel of the DISTRICT to enter his premises at any time during the day for the purpose of delivery of waterbil, corespondence and other related water service activities, 6. Allother policies, rules and regulations that may hereinafter be formulated by the District's Board of Directors shall form part of this policy upon proper public notification. Relevant issuances also from the Local Water Utilities Administretion and applicable stipulations of PD 198 and RA 8041 are to be observed and considered part of this Contract. 7. Should there be any iregularities on any of the documents submitted attached to the application, the DISTRICT shall have the righ: to terminate this Contract 8. Should the CONCESSIONAIRE fail to comply with any agreement and policy, the DISTRICT may terminate this contract with prior notification. Termination of contract wil mean discontinuance of water service to concerned concessionaire. IN WITNESS WHEREOF, the PARTIES have affixed this signatures this in Manolo Fortich, Bukidnon, Signature of Applicant Signature of Household Lot Owner Printed Name Printed Name Recorrmended by: EVELYN CALIXTRO-NARA CSA-A, Commercial Section Approved by: ENGR. ROGELIO K. PANGAN General Manager ACKNOWLEDGMENT REPUBLIC OF THE PHILIPPINES SS, Before me. this in . Philippines, personally appeared, ENGR. ROGELIO K. PANGAN, with UMID ID NO. CRN 8061-04703 issued on October 1, 2003 at Cagayan de Oro City and with ID No issued on at known to me to be the same person who executed the foregoing instrument and acknowledge to me that the same is their free and voluntary act and deed. Witness my hand and official sel. Doc. No. Page No. Book No. NOTARY PUBLIC Series of