Download File - Rosales Water District

R O S A L E S W A T E R D IS T R IC T
N 0 . 5 B o n ifa c io S t. Z o n e II, R o s a le s , P a n g a s in a n
T e le p h o n e N o . (0 7 5 ) 5 8 2 -3 5 5 0 ; (0 7 5 ) 5 8 2 -3 9 5 0 ; T e le fa x N o . (0 7 5 ) 5 8 2 -2 6 4 2
E m a il a d - r o sa lw d @ y a h o o .c o m
A P P L IC A T IO N
F O R A V A IL M E N T
SE N IO R C IT IZ E N U T IL IT Y
D ISC O U N T
I n c o m p l i a n c e w i t h R A N O . 9 9 9 4 A r t i c l e 1 2 a n d L W U A M C N o . 0 0 8 .1 0
N a m e:
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A d d ress:
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D a t e o f B ir t h :
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A cco u n t N a m e:
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A cco u n t N u m b er:
C la s s s if ic a t io n :
S e c tio n . 1 .
( f o r in s t it u t io n s , d a t e o f r e g is t r a t io n )
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T o a v a il o f th e 5 %
d isc o u n t, th e se n io r c itiz e n sh a ll:
T T o
1 . A p p ly fo r th e d isc o u n t p e rso n a lly o r th ru a re p re se n ta tiv e . T h e re sh a ll b e a n a n n u a l
re n e w a l o f a p p lic a tio n to th e w a te r d istric t.
2 . S u b m it th e fo llo w in g re q u ire m e n ts:
a . p ro o f o f a g e a n d c itiz e n sh ip
B irth C e rtific a te
O ffic e o f th e S e n io r C itiz e n A ffa irs (O S C A ) Id e n tific a tio n C a rd
b . P ro o f o f b illin g , M e te r re g istra tio n sh o u ld b e in th e n a m e o f th e se n io r c itiz e n fo r a
p e rio d o f o n e y e a r
R o sa le s W D S ta te m e n t o f A c c o u n t
R o sa le s W D O ffic ia l R e c e ip t
c . p ro o f o f re sid e n c e
C o m m u n ity T a x C e rtific a te
B a ra n g a y C le a ra n c e
N o te : C o m m e rc ia l E sta b lish m e n ts u n d e r th e n a m e o f th e se n io r c itiz e n a re n o t
in c lu d e d
in th is b e n e fit.
S e c tio n 2 . F if ty ( 5 0 % ) D is c o u n t – F o r D S W D - a c c r e d it e d s e n io r c it iz e n s c e n t e r s a n d
re s id e n tia l c a re , in s titu tio n s o r g ro u p h o m e s th a t a re g o v e rn m e n t -ru n o r o rg a n iz e d
and
o p e ra te d
p u rp o se
of
by
n o n -s to c k , n o n -p ro fit
p ro m o tin g
th e
w e ll- b e i n g
d o m e s tic
of
c o r p o r a t i o n s , p r i m a r i ly
abandoned,
n e g le c t e d ,
fo r
u n a tta ch e d
th e
or
h o m e le s s s e n i o r c i t i z e n s , t h a t m u s t h a v e b e e n i n o p e r a t i o n f o r a t le a s t s i x ( 6 ) m o n t h s
a n d m u s t h a v e a s e p a r a t e m e t e r f o r s a i d u t i li t i e s / s e r v i c e s .
_ _ _ _ _ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
D a te :
_ _ _ _ _ _ _ __ __ __ _
A p p lican t (sig n atu re o v er p rin ted n am e)
E v alu ated b y :
R eco m m en d in g ap p ro v al b y :
A pproved by:
B E N J A M IN C . S A Y S O N , J R .
L A U R A S . C A U S IN
U tilities C u sto m er S erv ice O fficer A
D ep artm en t M an ag er C
G eneral M anager C
D ate:
D ate:
D ate:
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J O H N A . U L P IN D O
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