ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT:- COMPLAINTS REGARDING WATER SUPPLY Token Number (For Office Use) Date:- / / Citizen Identification Number (If Citizen Identification Number is given, do not fill below Details) Applicant's Details: Last Name/ Surname Name Father/Husband's Name Details of Society (If Application from Society): Name Of Society: Designation Address: Head Information House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Ward Committee No.: 1 [ ] 2 [ ] 3 [ ] 4 [ ] Electrol Panel No.: Telephone No. (if any): Contact Person: Email Address (if any): Information of Water Connection:- Water Connection No (Computerized): Classification: - (Tick [ ] whichever applicable) [ ] Delay in giving permission for new water connection. [ ] Delay in connecting new water connection. [ ] Illegal/ unauthorized water connection. [ ] Irregular water supply. [ ] Shortage of water supply. [ ] Contaminated water supply. [ ] Booster pumps connected to water connections. [ ] Lickage in water pipe lines. [ ] Water meter is not in working condition . [ ] Water meters not functioning properly. [ ] Meter reading not taken properly. [ ] Water bill not received . [ ] Excess bill received. [ ] Repairing of Borewells. [ ] Use of Residential water connection for non- residential purpose. [ ] Others Details of Complaint:- Applicant's Signature [Note:- Please attach necessary documents regarding Complaint.]
