BAGUIO WATER DISTRICT Document No.

NWC-
WSCA2019_F013
Effectivity Date September 2019
z
WATER SERVICE CONNECTION APPLICATION Revision No. 1

Service Application Number: ___________________

Date Applied:

Application for Water Connection

Name of Applicant
Name of Husband/Wife
Address/ Location of Installation
Telephone Number
Cellphone Number

Landmark/Nearest Neighbor
Account Number / Serial Number

Residents:
Above 13 years old:
M: _____ F: _____
Type of Application
New Connection
Below 12 years old:
Additional Meter and Tapping
M: _____ F: _____
Additional Meter with Common Tapping
Transfer of Tapping due to:
Reconnection of Disconnected Meter
Re-tapping of Service line
Others:

Type of Building Structure

Residential Hotel / Inn / Restaurant

Apartment School / Institution

Condominium / Townhouse Church / Seminary / Convent

Others (please specify) :

Do you wish to have your service line (line after the water meter in your premises) installed by BWD?
Yes No

Yes No
Do you have a previous water connection with the BWD?
If Yes, please state the Address :
Account Number :

Do you have an existing water connection with the BWD? Yes No

If Yes, please state the Address :

Account Number :

Data Verified and Confirmed by:

CUSTOMER SERVICE ASSISTANT

NAME & SIGNATURE OF APPLICANT

AUTHORIZED REPRESENTATIVE

*Not valid if with alterations