ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT:- NEW WATER CONNECTION APPROVAL FOR PROTECTED SLUM DWELLERS UNDER MAHARASHTRA SLUM DEVELOPMENT POLICY 1971 Token Number (For Office Use) Date:- / / (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 Property: Head Information Type of Property (Please Tick [?] as applicable) [ ] Land [ ] Building Property Number (Computerized) Necessary Particulars about above service: Head Information 1 Group Leader Name Address where Group water connection is required House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: 2 Ward Committee No.: 1 [ ] 2 [ ] 3 [ ] 4 [ ] Citizen Identification Number 3 Type of Property (Please Tick [?] as applicable) [ ] Slum dwellers [ ] Group of slum dwellers 4 Usage Type (Please Tick [?] as applicable) [ ] Residential [ ] Non-Residentail [ ] Mixed 5 Installation of water meter for the connection. (As applicable) [ ] Yes [ ] No 6 Number of Rooms fetching water from Group Connection 7 Number of Families Number of Persons 8 Old Water Connection Consumer No.: (if any) Necessary Enclosures related to above application are enclosed as under. (Please tick [ ? ] for YES or tick [?] for NO) Enclosures Yes/No 1 Residence proof of slum dwellers before 1995 (Any of the following) A) Ration Card B) Proof showing that the elecritricity connection is prior to 1995 C) Proof showing that the property is assessed before 1995 D) Photo Pass of Slum dwellers [ ] 2 Assurance letter for payment of Water Bills from any of the persons in the slum dwellers group [ ] 3 Location Map of Property [ ] Declaration I/We ................................................................................................... state on solemn affirmation that the above information is true and correct to the best of my/our knowledge. If the information given is found wrong then the given water connection would be disconnected without any prior notice to me/us, and also the amount charged by corporation as per rule, should be paid by me/us is/are binding on me/us. But if I/We am/are failed to pay within the given period then the amount can be deducted from my/our security deposit and I/We am/are aware that corporation has full authority to disconnect my/our water connection. And also its my/our responsibility to keep my/our water meter in working condition, and if it fails to work then I/We should repair it or shall be liable to pay the water charges along with penalty. Date:- Applicant's Signature ( ) The document may please be delivered to: 1. Self/Nominated Person [ ] a) C.F.C. [ ] b) Camp No. [ ] Name of Nominated Person (________________________________________________) 2. By Post a) U.P.C. [ ] b) Register A.D. [ ] 3. Currier [ ] (Not to be filled if address is same as above) Correspondence Address:- Last Name/ Surname Name Father/Husband's Name House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Email Address (if any):
