LOCATION SKETCH Make brighter memories with your family. Get started by applying for your electric service. NEAREST LANDMARK: LIST OF APPLIANCES FOR ESTIMATED LOAD CAPACITY + Fluorescent Lights + Incandescent Bulbs + Electric Fan “ + Refrigerator * Aircon * Iron + Rice Cooker + Stereo/Karaoke HPT TITIIt To be filled by Meralco Personnel: TYPE OF APPLICATION New Connection Temporary Service Separation of Service Recontract of Service Service ID no.EMTs amour Maino a family. Get started by applying for your electric service, » CUSTOM INFORMATION Application Reference "Required Fields Number: First Name* Middle Name Last Name* Mobile Number* Landline Email Address* Birthday. E ADDR Number/Floor, Building Name, Street Name, Subdivision* Barangay City or Municipality* Province Is the service address same with the billing address? Yes. No (SKIP IF SAME WITH THE SERVICE ADDRESS.) Number/Floor, Building Name, Street Name, Subdivision* Barangay City or Municipality* Province. Will someone else be processing your application? Yes No 1ON ONE ELSE \. SKIP IF NOT APPLICABL First Name* Middle Name Last Name* Number* Landline Email Address* Relationship to customer Relative Friend Employee Contractor Ti By signing below, | have read, agree, and consent to the Privacy Policy of Meralco. Customers Signature over Printed Name Date SubmittedAUTHORIZATION Re: Service Application No Date Manila Electric Company Dasmarifias-Tagaytay Business Center Aguinaido Highway Bray Abubot Dasmarifias Cavite Gentlemen | hereby authorize 2 to act as my representative in connection “with 0 wit! ivy gw cepiestone mmole a cect, © a scuiceisa @ ger __ (the “Application”) and, for such purpose: execute or sign any and all of the following documents on my behalf aes - _____ Requirement/s — 1_| Contract 2 | soa 7 — . 3 | MSIF = - . - is [Customer's Service Application Werronty — : s | submit any and all required papers or documents and pay all to transact with your Company, the processing of my Application; necessary fees and deposits in connection with and to facilitate AND 2. todo any and all acts necessary for the processing of my Application By executing this Authorization, | hereby affirm and agree to be bound by the representations, warranties and actions of my representative and to comply with the terms and conditions for the provision of electric service at the address aforementioned In case there are changes in the foregoing authorization, | undertake to immediately notify Meralco of any andall such change/s; and | will defend, protect, indemnify and hold Meralco and its officers, directors, representatives and agents free and harmless from, and against any and all, delays, losses, liabilities, demands and claims of whatever nature and kind, arising out of my failure to make such notification For your reference, attached are photocopies of my ID and that of my representative / Va Applicant Signature Over Printed Name Authorized Representative Signature Over Printed NameCUSTOMER'S SERVICE APPLICATION WARRANTY! {For individuals) Applicant authorized Representative, if any Service Address Application Number ‘The undersigned (“Applicant”) hereby warrants and represents that | am the oy/ner/possessor of the property subject of this electric service application and as such, has the full power and authority to use, occupy/ possess and/or use the same and to allow and authorize the MANILA ELECTRIC COMPANY {"MERALCO") to enter into the said property and install therein the needed electrical facilities in connection with this application, Applicant shell defend, protect, indemnify and hold MERALCO, its officers, directors, employees, agents and representatives free and harmiess from and against eny and all claims, demands, actions, liabilities and damages which may be brought against them by any party in connection with the ownership, use, possession and/or occupancy of the property herein and the installation of the eletrical facilities pursuant to this application; Applicant fully understands thet any violation and/or breach of this Customer's Service Application Warranty shall entitle MERALCO to refuse, disconnect and/or terminate the Applicant's electric service without prejudice to its other remedies under the electric service contract and applicable laws, rules and regulations. The Applicant further waives and relinquishes whatever right the Applicant may have as to the disconnection of his/her/its electric service, the removal of electric facilities and/or termination of contract upen breach of the warranties and representations herein and/or the occurrence of any of the following circumstances 1. When the lawful owner of the land/structure/right of way where the elect tric facilities or termination of the electric service; When the disconnection and/or removal of electric service is upon lawful order, regulation or decision of any competent court, body or government authority; 3. In case of emergency or when public safety so requires; 4. When an illegal or flying connection Is tapped to the electrical facilities that serve the Applicant; 5. When the meter is illegally relocated or the load-side wires are diverted to other service/s; 6 When any information or document presented or submitted to MERALCO in connection with the Applicant's electric service applicetion was found to be fraudulent, inaccurate, false, fake or forged; 7. When the Applicant or any of its personnel/agent isin violation of any of the unlawful acts enumerated in Section 4a) of RA. 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 the date of energization or whenever requested or required by MERALCO; or 9. Any violation of the terms and conditions for electric service of MERALCO oF of any provision of such other applicable fews, rules and regulations relating to the electric service connection of Applicant. demands the removal of rvice is pro Thereby voluntarily sign this instrument on day of. 20, at. if by 2 representative: Position/Relationship to Applicant Signed in the Presence of: Signature over Printed Name Signature over Printed Name | This document sholl not prevent Meraiga from collecting any arrears of unpoid Bilis of the Appiicont o¢ from disconnecting the Applicant's electri¢ service on account of such orrears or unpatd bills. Any delay or leniency by Mergica in the enforcement, in viho‘e or in part, of any right, remedy, or obligation provided herein and the retevant Contract for Electric Service shall not constitute @ woiver of any such right, remedy, or obligation.DATA PRIVACY CONSENT STATEMENT Thereby give consent to, and authorize Manila Electric Company (MERALCO), its directors, officers, employees, authorized representatives or third parties, to collect, record, store, use, disclose, share, update, modify, block or erase, monitor, or otherwise process (collectively, “Process/Processing") my Personal Data, in accordance with R.A. No. 10173 “The Data Privacy Act of 2012" and its implementing rules and regulations and any of its amendments. These Personal Data refer to all personal, sensitive or confidential information provided or to be provided to Manila Electric Company (MERALCO), its directors, officers, employees, authorized representatives including but not limited to the following: 1. Information given when applying for service, such as my name, address, phone number, email address, Tax Identification Number (TIN), evidence of authority to occupy, and, if applicable, details of my authorized representative; 2. Billing and payment information used to pay my electric consumption. However, details of the payment instrument (like prepaid card, debit card, credit card) used to pay my bills via Meralco Online are captured and processed by the payment gateway service provider, 3. Information to determine eligibility to participate in certain energy programs or services; 4. Information | filled out in any form on our website or online facilities, such as, when | wish to contact Meralco to lodge my concerns, to register at Meralco Online, to avail of its on-line application, outage notifications, and billing and/or payment services; 5. Information given when | communicate with MERALCO andor any of its representatives (e.g., Call Center Representatives, etc.); 6. Responses provided when | or my representative participate in our customer surveys; 7. Information provided for verification purposes (€.g., to facilitate refunds or to avail of zero-rated VAT transactions; 8. Any other information voluntarily provided for any legitimate purpose declared at point of collection of such information. agree that these data shall be used and/or processed for any legitimate purpose, including but not limited to the following a. Notification on the service application, bill payments, outages, marketing or promotional information, updates, alerts, or other concerns; b. Supply or continuous improvement of the electric service as well as management of the service account such as payment options and eligibility for refunds; cc. Response to service inquiry, concer or complaint; 4d. Verification of identity whenever accessing the account through the various customer engagement channels (e.9., ¢-mail, website, mobile application, via phone call, walk-in); e. Conduct of research involving the business of MERALCO or electric distribution services, in general; f. Protection of my interest and/or that of other MERALCO customers; or g. Compliance by MERALCO with its obligations under its contract, applicable laws and regulations or pursuant to lawful orders of ‘competent authorities or for public order and safety or in cases of emergencies | acknowledge that | am afforded certain rights such as the right to verify, correct or modify, or remove these personal data or withdraw my consent and/or edit my consent preferences at any time through a written request to MERALCO’s authorized representatives. | hereby agree that said personal data shall not be shared by MERALCO to third parties except to those provided above, or in special circumstances where | have given my specific consent or as allowed by pertinent laws, rules, or regulations. | acknowledge that said third parties have been required to abide by the Non-Disclosure Agreement, if applicable, and implement their own data privacy Program to secure and keep the subject information confidential in accordance with law. 'hereby warrant that | have read and carefully understood MERALCO's Privacy Policy, stated in http://www.meralco.com phiprivacy- policy, and that | knowingly and voluntarily executed this consent statement in accordance therewith. | confirm that | have obtained prior consent from the registered customer or applicant residential owner or user, company or business | represent and its officers before disclosing their information to MERALCO and in providing this consent in their behalf thereby allow MERALCO, its directors, officers, employees, authorized representatives or third parties to process these personal data from their submission and for the duration of my electric service contract with MERALCO until there are. unpaid bills, charges, deposits or refunds on the service account and in case the application does not proceed, the data shall be stored and/or processed only within twelve (12) months from submission or last updating of the data, subject to the retention limits set by applicable laws and regulations. Thereafter, the personal data shall be disposed or discarded in a secure manner that would prevent further processing, unauthorized access, or disclosure to any other party or the public. Name of Customer/Representative ‘Company/Business Entity Position Date