WAIVER1

Applicant :✓ RIA ALYSSA S. TRIA

Authorized Representative, if any : ENGR. CHRISTIAN F. HERMOZURA
Service Address : BLK 11 LOT 6, CENTERRA CABUYAO
Service ID Number/Application Number :

I hereby waive, relinquish and quitclaim whatever right I may have against the disconnection of my electric
service, the removal of electric facilities and/or termination of contract under the above-mentioned SIN, after notice,
by Manila Electric Company (Meralco) or any of its authorized representatives, upon the occurrence of any of the
following circumstances:

1. When the lawful owner of the land/structure/right of way where the electric service is provided demands
the removal or termination of the electric service;
2. When the disconnection and/or removal of electric service is upon a lawful order, regulation or decision of
any competent court or government authority;
3. In case of emergency or when public safety so requires;
4. When an illegal or flying connection is tapped to my service;
5. When the meter is illegally relocated or the load-side wires are diverted to other service/s;
6. When any information or document I presented or submitted to Meralco in connection with my application
for electric service was found to be fraudulent, false or forged;
7. When I am in violation of doing any of the unlawful acts enumerated in Section 4(a) of R.A. 7832 otherwise
known as the “Anti-Pilferage Act of 1994” and its Implementing Rules and Regulations;
8. Failure to submit or comply with any requirement for service application within one hundred twenty (120)
days from date hereof; or
9. Any violation of the terms and conditions for electric service of Meralco.

I hereby voluntarily sign this Waiver this ___________ day of ___________________ 2021, at
________________.

✓ RIA ALYSSA S. TRIA ENGR. CHRISTIAN F. HERMOZURA

Signature over Printed Name Representative
Applicant Relationship to Applicant

Signed in the Presence of:

Signature over Printed Name Signature over Printed Name

1This Waiver shall not prevent Meralco from collecting any arrears or unpaid bills of the Applicant/Customer. Any delay or
leniency by Meralco in the enforcement, in whole or in part, of any right, remedy, or obligation provided herein and the relevant
Contract for Electric Service shall not constitute a waiver of any such right, remedy, or obligation.