Information of Water Connection: Information Consumer No. (Computerised): Necessary Particulars about above service: Information Type of Transfer [ ] Due to sale of property from old property holder to new property holder [ ] Name of the tenant due to property given on live license. [ ] Due to change of tenant, name of new tenant is given [ ] Water connection in the name of the property holder due to removal of tenant. [ ] Water connection in the name of nominee of the property holder. Reasons for Transfer Name of New Water Connection Holder Father/ Husband's Name Necessary Enclosures related to above application are enclosed as under. (Please tick [ 9 ] for YES or tick [U] for NO) Yes/No Permission letter from original water connection holder (On Stamp paper of Rs. 20) [ ] Proof of ownership of property for which water connection required [ ] Up-to-date receipt of Water bill paid [ ] 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:- Father/Husband's Name House/Building/Soc. Name: Wing/Floor: Road/Street/Lane: Taluka: Pin code: Email Address (if any):
