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MERALCO Service Application Form
MERALCO Service Application Form
MERALCO Service Application Form
I FoRh/r
SERVTCE rDEilTlFlCAlrOr{ r{0. : En riorntt* fiComrnau* B{*EBo
ilAtrE oFcu$TOilER:
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APPLISATOI{ DATE: TEt EPKtrIEtrELL PTIOT{E }IO.:
ADDRES$:
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tlew Conneciion flGrantofRightof-Way
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fl Coreor*eSmwyCsfficala TIN
Separanon of Service ft Oixonnwton Wa{rer {Fonn to ba EI Cedincate d Re$aldion f&rinaee
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Transbrof Service
ReconnedknlRe+onfact
fl tlotriza Urder*irq {Form h be i$$red} fl g,oir,or, DII kmil
flfo.oScheduleoElec{ricatPlar El SpaciaPousrdAftrrry
n Relocdiwrof Meter flrrarsucauncamotfirc fl nmoavit
n Remodel of Salice Entrance f] ueeo ot Sae / Certfrcah ol Sals f] ainn I Oe*r, Mani,age Cefficah
flE Terminstion ol Contract
ModMion of Contrac{ Data
fiConfacttosdDssdolCondiliofldsah fl fw{Taxldentifica&nl{uttbf,}
f] OeeO otOonatlur
fl Temporary Seruice with Msbr I nHa Cart'fcalion (Rep.lr a{lpriat lo rard t gl d dmmctE} &
ft Temporary Seruice uithurt ltreter fl tttt* Cart h Csnnrsod ruilid Bonsfidaies fl vau D d Rsgh*md Crsms
tr TOU f] leu Certiftdon tEM00 aM UPAo) El vg D ol Roprwilafirr
n iletaNcsinili*d, Now
flBarangay Csrtitudion
I Cerunc*e from Issodalinn
I v*otDotPnoper]0urnr
fl0aOarmroiRsdPmpertlrCaplhtGaimTax fJ rcnas: p
md &wnment lDs, Old Vsfl$on of TIN/ SS$ GSIS/ Phil lloaffi/ V6s lDl Pag-illig l0 ud$oul &ts, Erargaf Cirffi* tiilt }rd &e
d tre barangay, Benangay Cortifidalo but bo8r $rt*m erd ey
of Bgy. C,hefrmm or any offmr d & ffi ofihp wffi ap$cuCs plcttt.
Las Pillas Brshrcs Ccriler/ Telephorul No. 372-56051Fax No. 1022-7rt05I Emaih hsginer.btSmer*l.oom.ph
f{allhg Addmsr: Ahbffie-Zopds Rord cor. Elm Orivc, Prmphna lt, Ler Plllao Cfry 1750