ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT:- NEW WATER CONNECTION FOR AUTHORISED CONSTRUCTION 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 Address of Property where water connection is required 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 [ ] Citizen Identification Number 2 Type of Property (Please Tick [?] as applicable) [ ] Chawl [ ] Bunglow [ ] Apartment 3 Building Commencement Certificate No. Date 4 Usage Permission Certificate No. Date 5 Usage Type (Please Tick [?] as applicable) [ ] Residential [ ] Non-Residentail [ ] Mixed 6 Installation of water meter for the connection. (As applicable) [ ] Yes [ ] No 7 Number of Flats/Rooms in Society/Chawl 8 Number of Families Number of Persons 9 Old Water Connection Consumer Number (if any) Necessary Enclosures related to above application are enclosed as under. (Please tick [ ? ] for YES or tick [?] for NO) Enclosures Yes/No 1 Location Map of Property [ ] 2 Attested copy of Building Commencement & Usage Permission Certificate [ ] 3 No objection certificate from Owner on Rs.20/- Stamp Paper, if the applicant is tenant [ ] 4 No objection certificate from concerned Society or Owner for Non-residential use of water [ ] 5 Up-to-date receipt of Water bill paid, if the applicant is having old water connection [ ] 6 Up-to-date receipt of Tax bill paid [ ] 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):
