Promissory Note

Nature of PN:
Water Bill/s
Miscellaneous Charges
Guarantee Deposit Project Amortization Cost Unmigrated AR- Water
Installation Cost- Water Restoration Charges
Installation Cost- Sewer Unmigrated AR- IC

I, Name of the registered customer, hereby acknowledged indebtedness to the Maynilad Water Services, Inc.
(MWSI) in the total amount of Amount in words (₱Amount in numbers). I hereby promise to pay Maynilad on installment
basis the above total amount representing my total unpaid balance under the following conditions: (1) Down payment
amounting to ₱ Amount in numbers; (2) the balance of ₱ Amount in numbers shall be paid as indicated on the table below:

It is understood, that aside from the above payments, I will pay the monthly current bills on or before due date. In
the event of default of any installment and/or current bill, I agree that: (1) the total unpaid amount becomes due and
demandable; (2) disconnection shall be executed if full payment is not made; (3) Maynilad may take such legal steps that it
may deem appropriate, to effect collection of all unpaid accounts which remain unpaid after their due date without
prejudice to Temporary or Permanent Closure due to Delinquency (TCD/PCD) of the water service.

In view thereof, I promise to pay Maynilad in accordance with the terms and conditions hereinafter stipulated.

SCHEDULE OF PAYMENTS

Miscellaneous Charges Total

Seq. Amount
Due Date Water Bills
No. Guarantee Installation Installation Restoration Project Unmigrated Unmigrated
Deposit Cost (Water) Cost (Sewer) Charges Amortization AR (Water) AR (IC)

TOTAL:

Prepared by :
Signature over Printed Name
BA Specialist

Acknowledged by : Signature :
If representative, relationship to registered customer: Date :

Address :
Tel. No. : Approved by:
CAN :
MRU/ Zone :
BA Head
Signature over Printed Name
Head, Choose an item
Choose an item
Date of Approval:
Original: Customer's Copy
Duplicate: Business Area Copy

MAYNILAD WATER SERVICES, INC. | MWSS COMPLEX, KATIPUNAN AVE., BALARA 1105 QUEZON CITY, PHILIPPINES |
Revision 4 Hotline1626 for Metro Manila and 1-800-1000-WATER (92837) for Cavite customers
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