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Water Supply Application Guide

This document is a Certificate of Public Convenience application from the Naic Water Supply Corporation to the National Water Resources Board for a water supply permit. It provides details about the applicant such as their name, address, source of water (deep well), and service area (Barangay San Roque, Naic Cavite). It lists the type of water system as direct pumping and the number of connections as well as documentary requirements that must be submitted with the application such as articles of incorporation, water distribution plans, financial statements, and a proposed tariff schedule. The representative of the water utility signs to certify the accuracy of the information provided in the application.

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1K views2 pages

Water Supply Application Guide

This document is a Certificate of Public Convenience application from the Naic Water Supply Corporation to the National Water Resources Board for a water supply permit. It provides details about the applicant such as their name, address, source of water (deep well), and service area (Barangay San Roque, Naic Cavite). It lists the type of water system as direct pumping and the number of connections as well as documentary requirements that must be submitted with the application such as articles of incorporation, water distribution plans, financial statements, and a proposed tariff schedule. The representative of the water utility signs to certify the accuracy of the information provided in the application.

Uploaded by

Sarah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Republic of the Philippines CERTIFICATE OF PUBLIC CONVENIENCE

NATIONAL WATER RESOURCES BOARD FOR WATER SUPPLY APPLICATION


8th Floor, NIA Building, EDSA, Quezon City
Telefax : 920-27-14 CASE NO.
PLEASE ACCOMPLISH THIS FORM IN SIX (6) COPIES
NAME OF APPLICANT MAILING ADDRESS WATER PERMIT NO. 03-24-17-029
003 Cap. C Nazareno Street, Naic Cavite
Naic Water Supply Corporation CONTACT NO.
SOURCE Deep Well
LOCATION Brgy. San Roque, Naic Cavite
CITIZENSHIP TIN DATE OF OPERATION

SERVICE AREA Existing CPC/N No., if for renewal FILING FEE


Subdivision:
a. Amount ____________
Barangay: San Roque
b. O. R. No. ___________
Provisional Authority Required
Municipality: Naic c. Date ________________
Yes No
Province: Cavite
TYPE OF UTILITY NO. OF CONNECTIONS
[ ] Subdivision / HOA a. with water meters _____________________
[ ] Rural Water & Sanitation Association b. w/o water meters ______________________
[ ] Cooperative c. meter tested ____________________
[ ] Bulk Water Seller/Peddler c.1 tested by ____________________
[ x ] Others ________________________ c.2 date tested ____________________
(specify) d. for bulk seller /peddler
Average volume of water delivered in cubic meters per day
________________________
KIND OF WATER SYSTEM
[ ] Draw & Fill [ ] Float [ x] Direct Pumping

LIST OF DOCUMENTARY REQUIREMENTS


NOTE: USE 5- YEAR TARIFF MODEL TO COMPLY ON
FINANCIAL REQUIREMENTS
( ) Articles of Incorporation/Partnership/ DTI Registration ( ) Latest Audited Financial Statement ¹
( ) Board resolution (for corporations and partnerships) or ( ) Actual Balance Sheet for Water Operations ¹²‫׳‬
special power of attorney (for single proprietorships) ( ) Actual Income Statement for Water Operations ¹²‫׳‬
authorizing the signatory to sign and file the application ( ) List of Existing Assets in Service Subject to Return ¹
( ) Copy of Approved Water Permit/s Itemized Projected Financial Statements for Water
( ) Copy of Official Receipt/s of Annual Water Charges Operations for 5 years
( ) Copy of Latest Certificate of Potability issued by ( ) Income Statements
City/Municipal Health Officer where source is located ( ) Funds Flow
with Results of Bacteriological, Physical & Chemical ( ) Balance Sheet
Impurities conducted by laboratory of DOH ( ) Assumptions
( ) Plan of Water Distribution System ( ) Business Plan & Itemized List of Required Investments
( ) Plan, Elevation of Cross-sectional Views of for the Next 5 yrs.
Tank/Reservoir ( ) Proposed Tariff Schedule
( ) Plan, Elevation of Cross-sectional Views of Pump House, ( ) Levels of service agreed with consumers commensurate
Machinery & Equipment with proposed rates
( ) Others

1 For new CPC applicants, last 2 years


For old applicants, last 2 years
2 If applicant has another operations other than water supply
I HEREBY CERTIFY THAT THE INFORMATION SUBSCRIBED AND SWORN TO BEFORE ME ON THIS DATE
GIVEN ABOVE AND THE DOCUMENTS
SUBMITTED ARE TRUE AND CORRECT TO THE
BEST OF KNOWLEDGE AND BELIEF

NILA T. BARIA
Signature of Water Utility Representative Notary Public / Administering Officer

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