NWRB-WUD-09-r3
Republic of the Philippines
NATIONAL WATER RESOURCES BOARD
8th Floor NIA Building, EDSA, Quezon City
Telefax (02) 8920-2714
APPLICATION FOR
CERTIFICATE OF PUBLIC CONVENIENCE
Accomplish this form in six (6) copies.
Attach separate sheet if more space is required.
Water Service
Provider (WSP)
Category: {{ $application->cat_id }}
Case Number
Name of Applicant: {{ $application->applicant_name }}
Mailing Address
Email Address
Contact No.
Citizenship
TIN
Year Operations Started
Filing Fee Amount
OR No.
Date Paid
Location of Service Area
Subdivision
Barangay
Municipality
Province
Type of Water Service Provider
Meters tested?
Kind of Water System
For Bulk Water Seller/Peddler,
Average volume of water delivered per day
(in cu. m.)
Water Permit Information
CWP/Water Permit No. Source Latitude Longitude Barangay Location of Source
Deg. Min. Sec. Deg. Min. Sec.
If water is bulk supplied, copy of agreement/contract/receipt
See back page for pertinent requirements
I hereby certify that the information given above and the documents submitted are true and correct to the best of my knowledge and belief.
Signature over printed name of Water Utility Representative
Subscribed and sworn to before me on this date:
Notary Public / Administering Officer
Date
ยน How to Determine the Water Service Provider Category
Category A
Category B
Category C

Water utilities operating for profit:

  1. Privately-owned or privately run WUs; or
  2. Government-owned and government-run WUs that opted to be classified or NWRB has classified as Category A; or
  3. Community-based WUs that:
    1. Have expanded/ are expanding outside original area of jurisdiction, or
    2. Opted to be classified or NWRB has classified it as Category A
Government-owned or controlled, and government-run WUs that do not opt to be classified as Category "A" or NWRB has classified as Category B

Community-based WUs that:

  1. Are not operating for profit;
  2. Have not expanded/ are not expanding outside their original area of jurisdiction; or
  3. Do not opt to be classified as Category "A"/"B" or NWRB has classified as Category "A"
National Water Resources Board
APPLICATION FOR
CERTIFICATE OF PUBLIC CONVENIENCE
Name of Applicant
Water Service Provider Category
Case Number
Documentary Requirements Cat. A Cat. B Cat. C
Articles of Incorporation/Partnership or DTI/CDA Registration
Authority to sign and file the application
  • Board Resolution for corporations and partnerships, or Board Secretary's Certificate
  • For single proprietorship, signed by owner or Special Power of Attorney
Copy of approved Conditional / Water Permit/s
If water is bulk supplied, copy of agreement/contract/receipt
Copy of latest Official Receipts of Annual Water Charges Not required when procuring bulk
Copy of recent Certificate of Potability (within 6 months) issued by the City/ Municipal Health Officer where the source is located, with results of bacteriological (within 3 months), physical and chemical (at least one year) impurity tests conducted by a Department of Health accredited laboratory
Plan duly signed by a licensed Engineer
  • Water distribution system
  • Elevation and cross-sectional views of tank/reservoir
  • Elevation and cross-sectional views of pump house, machinery and equipment

    • For Category C, only sketch plan is required
Latest audited financial statements for the waterworks operation only, if already in operation for 1 year

For Category C: Income Statement and Balance Sheet
Simplified Financial Projections Model for Category C (hard/soft copy) with the following data:
  • Revenue requirements for one year, composed of:
    • Operating expenses, with breakdown
    • Depreciation
    • Loan amortization (interest and principal) per year
  • Estimated total consumption for one year in cu.m
Business Plan containing:
  • List of existing/required investments consistent with the 10-year business plan
  • Proposed Tariff Schedule
  • Levels of service (e.g. water quality, water pressure, non-revenue water, number of hours of water supply per day)
Financial Projections Model for Category A/Category B (hard and soft copy)
Proposed Tariff (Downloadable form under Supplemental Guidelines in the Preparation of the Tariff Proposal)