Fault Data Request Form

CUSTOMER / REQUESTOR SECTION

Requestor's / Representative’s Information
Name: _______________________________________________ Contact Number: _________________
Company Name: _______________________________________________________________________
Position: _____________________________________________________________________________
Mailing Address: ____________________________________ E-mail Address: _____________________
Date Requested: _______________________________________________________________________

Customer's Information
Customer Name: _______________________________________ Contact Number: _________________
Mailing Address: ______________________________________________________________________
Service Identification Number (if existing): __________________________________________________
Transformer Location Number (if existing): __________________________________________________
Site and Location Address (if unknown): ____________________________________________________
If account SIN and TLN are not known, provide the complete site description and address of the location for the fault data analysis.
The request shall not be processed without the adequate information to determine the exact site location.

By signing and submitting this fault data request form, the Customer acknowledges that the Fault Data to
be released is (1) subject to change without notice and is only valid during the normal operations of the
Manila Electric Company (MERALCO); and (2) is strictly confidential and intended for information of
Customer only. Customer agrees and undertakes to use the Fault Data for exclusive purposes only.
Customer hereby releases, waives, and forever discharges MERALCO, its directors, officers,
employees, agents and representatives, from any and all actions and claims that now exist or may
thereafter arise by reason of losses or damages incurred as a result of reliance on or change in the
data, or Customer's unauthorized use or disclosure of the Fault Data.
Customer’s Signature: ______________________ Date Signed: _______________

MERALCO SECTION

Fault Data

CUSTOMER NAME: ___________________________CONTACT NUMBER: ____________________

SERVICE ADDRESS / SITE & LOCATION ADDRESS:

_____________________________________________________________________________________

SIN: _________________________ DATE OF SIMULATION: _______________________

SEQUENCE IMPEDANCES R X Impedance X/R Ratio Symmetrical Amps (A)

Z0
Z1
Z2
SLG Fault
3-phase Fault

Single-Line-to-Ground (SLG) Three-Phase (3Ph)

Transformer Location
Number / Circuit Number Fault Duty
Fault Duty (MVA) X/R X/R
(MVA)

Released by:
CSE / BPM / TSE: ________________________ Date Released: _________________