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Service Application Form

This document is a service application form for a utility provider. It requests information such as the applicant's name, address, contact details, and whether the account is residential or commercial. It outlines the different requirements for opening an account depending on factors like senior citizen status, property ownership, connection type, and payment method. These include documents like IDs, permits, certificates, and authorization letters. The form is to be filled out by both the customer and customer service assistant, with the original versions of certain documents to be presented.

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Mae Rachel Muyuela Lacson
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46 views1 page

Service Application Form

This document is a service application form for a utility provider. It requests information such as the applicant's name, address, contact details, and whether the account is residential or commercial. It outlines the different requirements for opening an account depending on factors like senior citizen status, property ownership, connection type, and payment method. These include documents like IDs, permits, certificates, and authorization letters. The form is to be filled out by both the customer and customer service assistant, with the original versions of certain documents to be presented.

Uploaded by

Mae Rachel Muyuela Lacson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SERVICE APPLICATION FORM

Date of Application: ________________________


Name (Last, Given, Middle): _______________________________________________________________
If commercial, Official Name of Establishment:_________________________________________________
Name of Authorized Representative: _________________________________________________________
Address: _______________________________________________________________________________
Landline: __________________ Mobile No: ________________________ Email: _____________________

(To be filled up by the Customer Service Assistant)

1. Is this a Senior Citizen Account? COMPLIANCE


1. Is this a Senior Citizen Account? YES NO YES NO
If Yes, the following are required:
a. Fill up application form for Senior Citizen Account
b. Office of the Senior Citizen’s Affairs (OSCA) Id Photocopy
c. Either Birth Certificate, Passport, License or any
Government issued documents (Photocopy)
2. Is this a Residential or Commercial Account? RESIDENTIAL COMMERCIAL RESIDENTIAL
If Residential, requirements are:
a. Two (2) Valid ID (Photocopy)
b. Barangay Clearance (Original)
If Commercial, requirements are: COMMERCIAL
a. Corporate SEC Certificate (Original)
b. Barangay Business Permit
c. Mayor’s Permit
d. Two (2) Valid ID of the authorized Rep.
3. Is the property owned by Applicant or Leased? OWNED LEASED
If Leased, requirements is Contract of Lease (Photocopy)
Or Authorization letter from Landlord (Original)

4. Is the connection Tapping, Plug or Across Soil Pavement? TAPPING PLUG ACROSS TYPE OF CONNECTION
If PLUG, requirement to get authorization (Original)
If ACROSS Pavement, Excavation Permit (Original)

5. Is SURVEY required? SURVEY


6. Is the customer paying in full or availing of installment or Promo?
Assessment of Fees: PAYMENT
GUARANTY DEPOSIT ______________ Full payment Full Installment
MATERIALS ______________ Php ______________
SERVICE FEE ______________
OTHERS ______________ Installment or Promo
No. of Months ________
TOTAL ______________ Php __________ / months

7. If a representative applying on behalf of the Customer? YES NO REPRESENTATIVE


If Yes, requirements are:
a. Authorization letter from customer (Original)
b. Valid Id of Representative ( Photocopy)
Note to CSA: Originals should be presented for items above where only photocopy should be submitted.
Conformed: Prepared by:
_________________________________ _________________________________
Customer’s Signature over Printed Name Customer Service Assistant
FM-CS-01

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