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Wednesday, 01 September 2010 05:30

Download Application Form for Closing of Water Connection: Ulhasnagar

Download forms for state: Maharashtra
Form Details
StateMaharashtra
DepartmentUnspecified
TitleApplication Form for Closing of Water Connection: Ulhasnagar
LanguageEnglish
Document Size147.9 KB
Text of the PDF document(for quick reference)
ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT:- CLOSING OF WATER CONNECTION (DISCONNECTION) 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) Information of Water Connection: Head Information Water Connection Consumer Number (Computerised): Necessary Particulars about above service: Head Information 1 Reasons for Disconnection of Water Connection Citizen Identification Number Necessary Enclosures related to above application are enclosed as under. (Please tick [ ? ] for YES or tick [?] for NO) Enclosures Yes/No 1 Up-to-date receipt of Water bill paid [ ] 2 Location Map of Property [ ] 3 Receipt of water bill paid from MJP Sub-Division Ambarnath upto 20/12/1994 or no dues certificate for the same. [ ] 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):
Last Updated on Friday, 17 December 2010 05:30
 

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