‫إﺳﺘﻤﺎرة ﺗﻐﻴﻴﺮ اﻟﺘﻌﺮﻓﺔ‬

TARIFF CHANGE FORM

TERMS AND CONDITIONS: : ‫اﻟﺸﺮوط و اﺣﻜﺎم‬

TARIFF CHANGE: :‫ﺗﻐﻴﻴﺮ اﻟﺘﻌﺮﻓﺔ‬

After the submission the application of tariff change the company will visit ‫ﺑﻌﺪ اﻟﺘﻘﺪم ﺑﻄﻠﺐ ﺗﻐﻴﻴﺮ اﻟﺘﻌﺮﻓﺔ ﺳﻴﺘﻢ زﻳﺎرة اﻟﻌﻘﺎر واﻟﺘﺄﻛﺪ ﻣﻦ ﺗﻄﺎﺑﻖ ﺷﺮوط اﻟﺘﻌﺮﻓﺔ‬
the property to check the conditions of the requested tariff, shown below: :‫اﻟﻤﻄﻠﻮﺑﺔ و ﻫﻲ ﻛﺎﻟﺘﺎﻟﻲ‬

TARIFF TYPE TERMS & CONDITIONS ‫اﻟﺸﺮوط و ا‰ﺣﻜﺎم‬ ‫ﻧﻮع اﻟﺘﻌﺮﻓﺔ‬

DOMESTIC RESIDENTIAL USE .‫إﺳﺘﺨﺪام ﺳﻜﻨﻲ‬ ‫اﻟﺴﻜﻨﻴﺔ‬

COMMERCIAL USED.
COMMERCIAL ‫إﺳﺘﺨﺪام ﺗﺠﺎري‬
COPY OF CR
‫ﻧﺴﺨﺔ ﻣﻦ اﻟﺴﺠﻞ اﻟﺘﺠﺎري‬ ‫اﻟﺘﺠﺎرﻳﺔ‬
RECOMMENDATION LETTER FROM
MINISTRY OF AGRICULTURE AND ‫رﺳﺎﻟﺔ ﺗﺰﻛﻴﺔ ﻣﻦ وزراة اﻟﺰراﻋﺔ‬
AGRICULTURE / FISHERIES FISHERIES
‫واﻟﺜﺮوة اﻟﺴﻤﻜﻴﺔ‬
10 FEDDAN OR MORE ‫ ﺳﻤﻜﻲ‬/ ‫اﻟﺰراﻋﻲ‬
‫ اﻓﺪﻧﺔ أو أﻛﺜﺮ‬10 ‫ﻣﺴﺎﺣﺔ اﻻرض‬

RECOMMENDATION LETTER FROM

TOURISM
MINISTRY OF TOURISM.
. ‫رﺳﺎﻟﺔ ﺗﺰﻛﻴﺔ ﻣﻦ وزارﻋﺔ اﻟﺴﻴﺎﺣﺔ‬ ‫اﻟﺴﻴﺎﺣﻲ‬
RECOMMENDATION LETTER FORM
MINISTRY OF COMMERCE AND ‫رﺳﺎﻟﺔ ﺗﺰﻛﻴﺔ ﻣﻦ وزارة اﻟﺘﺠﺎرة‬
INDUSTRIAL INDUSTRY.
THE POWER FACTOR TO BE
‫و اﻟﺼﻨﺎﻋﺔ‬ ‫اﻟﺼﻨﺎﻋﻲ‬
MAINTAINED NOT LESS THAN 0.9 % ٪٠,٩ ‫أن ﻻ ﻳﻘﻞ ﻣﻌﺎﻣﻞ اﻟﻘﺪرة ﻋﻦ‬
ALL THE TIME. ‫ﻓﻲ ﻛﻞ اﻻوﻗﺎت‬

GOVERNMENT OFFICICAL REQUEST FROM

THE ORGANIZATION
‫رﺳﺎﻟﺔ رﺳﻤﻴﺔ ﻣﻦ اﻟﺠﻬﺔ اﻟﻤﺨﺘﺼﺔ‬ ‫اﻟﺤﻜﻮﻣﻲ‬

The new tariff will be applicable from the date of site visit and after ‫ﺳﻴﺘﻢ ﺗﻄﺒﻴﻖ اﻟﺘﻌﺮﻓﺔ اﻟﺠﺪﻳﺪة ﻣﻦ ﺗﺎرﻳﺦ زﻳﺎرة اﻟﻌﻘﺎر و اﻟﺘﺄﻛﺪ ﻣﻦ ﻣﻄﺎﺑﻘﺔ اﻟﻨﺸﺎط‬
meeting the tariff terms and conditions. .‫ﻟﻠﺘﻌﺮﻓﺔ اﻟﻤﻄﻠﻮﺑﺔ‬

APPLICANT'S SIGNATURE ‫ﺗﻮﻗﻴﻊ ﻣﻘﺪم اﻟﻄﻠﺐ‬

Signature Date ‫ﺗﺎرﻳﺦ‬ ‫اﻟﺘﻮﻗﻴﻊ‬

For more information please our Call center 800 70008 or visit www.medcoman.com ‫ أو زﻳﺎرة ﻣﻮﻗﻌﻨﺎ اﻻﻟﻜﺘﺮوﻧﻲ‬٨٠٠ ٧٠٠٠٨ ‫ﻟﻠﻤﺰﻳﺪ ﻣﻦ اﻟﻤﻌﻠﻮﻣﺎت اﻟﺮﺟﺎء اﻻﺗﺼﺎل ﻋﻠﻰ ﻣﺮﻛﺰ اﻻﺗﺼﺎل رﻗﻢ‬
 ‫إﺳﺘﻤﺎرة ﺗﻐﻴﻴﺮ اﻟﺘﻌﺮﻓﺔ‬
TARIFF CHANGE FORM

DATE APP No ‫رﻗﻢ اﻟﻤﻌﺎﻣﻠﺔ‬ ‫اﻟﺘﺎرﻳﺦ‬

APPLICANT DETAILS ‫ﺑﻴﺎﻧﺎت ﻣﻘﺪم اﻟﻄﻠﺐ‬

Owner name (‫اﺳﻢ اﻟﻤﺸﺘﺮك )ﻣﺎﻟﻚ اﻟﻌﻘﺎر‬

Tenant (If applicable) (‫اﻟﻤﺴﺘﺄﺟﺮ )إن وﺟﺪ‬

(please attach a copy of the rent agreement) (‫)ﻳﺮﺟﻰ إرﻓﺎق ﺻﻮرة ﻣﻦ ﻋﻘﺪ اﻻﻳﺠﺎر‬
Account number ‫رﻗﻢ اﻟﺤﺴﺎب‬
Area Wilayat ‫اﻟﻮﻻﻳﺔ‬ ‫اﻟﻤﻨﻄﻘﺔ‬

Way No Building No Flat No ‫رﻗﻢ اﻟﺸﻘﺔ‬ ‫رﻗﻢ اﻟﻤﺒﻨﻰ‬ ‫رﻗﻢ اﻟﺴﻜﺔ‬

Premises type ‫ﻧﻮع اﻟﻌﻘﺎر‬

Domestic Industrial Commercial ‫ﺗﺠﺎري‬ ‫ﺻﻨﺎﻋﻲ‬ ‫ﺳﻜﻨﻲ‬
Agricultural Government Tourism/Hotel ‫ﺳﻴﺎﺣﻲ‬ ‫ﺣﻜﻮﻣﻲ‬ ‫زراﻋﻲ‬

Telephone GSM ‫اﻟﻬﺎﺗﻒ اﻟﻨﻘﺎل‬ ‫اﻟﻬﺎﺗﻒ اﻟﺜﺎﺑﺖ‬

Email address ‫ﻟﻜﺘﺮوﻧﻲ‬³‫اﻟﺒﺮﻳﺪ ا‬

PO Box PC ‫اﻟﺮﻣﺰ اﻟﺒﺮﻳﺪي‬ ‫ب‬.‫ص‬

I.D. Card No C.R. No (commercail accounts) (‫رﻗﻢ اﻟﺴﺠﻞ اﻟﺘﺠﺎري )ﻟﻠﺤﺴﺎﺑﺎت اﻟﺘﺠﺎرﻳﺔ‬ ‫رﻗﻢ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ‬
(please attach copy) (please attach copy) (‫)ﻳﺮﺟﻰ ارﻓﺎق ﺻﻮرة‬ (‫)ﻳﺮﺟﻰ ارﻓﺎق ﺻﻮرة‬

TARIFF CHANGE APPLICATION ‫ﻧﻮع ﺗﻐﻴﻴﺮ اﻟﺘﻌﺮﻓﺔ‬

CURRENT TARIFF ‫اﻟﺘﻌﺮﻓﺔ اﻟﺤﺎﻟﻴﺔ‬
Domestic Industrial Commercial ‫ﺗﺠﺎري‬ ‫ﺻﻨﺎﻋﻲ‬ ‫ﺳﻜﻨﻲ‬
Agricultural Government Tourism/Hotel ‫ﺳﻴﺎﺣﻲ‬ ‫ﺣﻜﻮﻣﻲ‬ ‫زراﻋﻲ‬
NEW REQUESTED TARIFF ‫اﻟﺘﻌﺮﻓﺔ اﻟﻤﻄﻠﻮﺑﺔ‬

Domestic Industrial Commercial ‫ﺗﺠﺎري‬ ‫ﺻﻨﺎﻋﻲ‬ ‫ﺳﻜﻨﻲ‬

Agricultural Government Tourism/Hotel ‫ﺳﻴﺎﺣﻲ‬ ‫ﺣﻜﻮﻣﻲ‬ ‫زراﻋﻲ‬

TARIFF CHANGE TECHNICAL REPORT ‫اﻟﺘﻘﺮﻳﺮ اﻟﻔﻨﻲ ﻟﺘﻐﻴﻴﺮ اﻟﺘﻌﺮﻓﺔ‬

Account No Meter No ‫رﻗﻢ اﻟﻌﺪاد‬ ‫رﻗﻢ اﻟﺤﺴﺎب‬
Last Meter Reading :‫آﺧﺮ ﻗﺮاءة‬

From the visit the condition for the requested tariff is met. ‫ﻣﻦ ﺧﻼل زﻳﺎرﺗﻨﺎ ﻟﻠﻤﻮﻗﻊ ﺗﺒﻴﻦ أن ﺷﺮوط اﻟﺘﻌﺮﻓﺔ اﻟﻤﻄﻠﻮﺑﺔ ﻣﺘﻮﻓﺮة‬

‫إﺳﻢ اﻟﻔﻨﻲ‬
Technician Name

Signature Date ‫اﻟﺘﺎرﻳﺦ‬ ‫اﻟﺘﻮﻗﻴﻊ‬

Customer service approval ‫إﻋﺘﻤﺎد ﺧﺪﻣﺎت اﻟﻤﺸﺘﺮﻛﻴﻦ‬

The new tariff has been approved from / / / / ‫ﺗﻢ إﻋﺘﻤﺎد اﻟﺘﻌﺮﻓﺔ اﻟﺠﺪﻳﺪة ﻣﻦ ﺗﺎرﻳﺦ‬

Signature ‫اﻟﺘﻮﻗﻴﻊ‬

APPLICATION RECEIPT ‫إﻳﺼﺎل إﺳﺘﻼم اﻟﻤﻌﺎﻣﻠﺔ‬

Application No ‫رﻗﻢ اﻟﻤﻌﺎﻣﻠﺔ‬

Application receipt date ‫ﺗﺎرﻳﺦ إﺳﺘﻼم اﻟﻤﻌﺎﻣﻠﺔ‬

Inspection / Visit date ‫اﻟﺰﻳﺎرة‬/‫ﺗﺎرﻳﺦ اﻟﺘﻔﺘﻴﺶ‬

Received by ‫اﺳﻢ اﻟﻤﺴﺘﻠﻢ‬

Signature ‫اﻟﺘﻮﻗﻴﻊ‬

For more information please call our Call center 800 70008 or visit www.medcoman.com ‫ أو زﻳﺎرة ﻣﻮﻗﻌﻨﺎ اﻻﻟﻜﺘﺮوﻧﻲ‬٨٠٠ ٧٠٠٠٨ ‫ﻟﻠﻤﺰﻳﺪ ﻣﻦ اﻟﻤﻌﻠﻮﻣﺎت اﻟﺮﺟﺎء اﻻﺗﺼﺎل ﻋﻠﻰ ﻣﺮﻛﺰ اﻻﺗﺼﺎل رﻗﻢ‬