NWRB Application Form

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

INCREASE OF WATER RATES

Accomplish this form in six (6) copies.

Attach separate sheet if more space is required.

Water Service
Provider (WSP)
Category¹ {{$application->cat_id ?? 'N/A'}}

Case Number
{{ $application->docket_code ?? '' }}

Name of Applicant
{{ $application->applicant_name ?? 'N/A' }}

Mailing Address
{{ $application->mailing_address ?? 'N/A' }}

Email Address
{{ $application->email_address ?? 'N/A' }}

Contact No.
{{ $application->contact_number ?? 'N/A' }}

Citizenship
{{ $application->citizenship ?? 'N/A' }}

TIN
{{ $application->tin ?? 'N/A' }}

Year Operations Started
{{ $application->year_operation ?? 'N/A' }}

Filing Fee Amount

OR No.

Date Paid

Location of Service Area

@if ($totalBarangays >= 5)

Subdivision	See the Checklist Location of Service Area Below
Barangay
Municipality
Province

@else @foreach ($newGrouped as $col) @endforeach @foreach ($newGrouped as $col) @endforeach @foreach ($municipalityGroups as $group) @endforeach @foreach ($municipalityGroups as $group) @endforeach

Subdivision	{{ $col['subdivisions'] }}
Barangay	{{ $col['barangay'] }}
Municipality	{{ $group['value'] }}
Province	{{ $group['province'] }}

@endif

Type of Water Service Provider

serv_id == 1 ? 'checked' : '' }}> Subdivision / Homeowners’ Association serv_id == 2 ? 'checked' : '' }}> Rural Waterworks and Sanitation Association serv_id == 3 ? 'checked' : '' }}> Cooperative serv_id == 4 ? 'checked' : '' }}> Bulk Water Seller / Peddler serv_id == 5 ? 'checked' : '' }}> Others, specify:

Number of Connections
With water meters Without water meters

Meters tested?
meters_tested == 'yes' ? 'checked' : '' }}> Yes meters_tested == 'no' ? 'checked' : '' }}> No

If tested, Tested by Date tested

Kind of Water System

kind_of_water == 1 ? 'checked' : '' }}> Draw and Fill kind_of_water == 2 ? 'checked' : '' }}> Float kind_of_water == 3 ? 'checked' : '' }}> Direct Pumping

For Bulk Water Seller/Peddler,
Average volume of water delivered per day
(in cu. m.)

Water Permit Information

@if ($rowPermit <= 4) @php $totalRows = 4; $countRows = count($rowsData); @endphp @foreach ($rowsData as $row) @endforeach @for ($i = $countRows; $i < $totalRows; $i++) @endfor @else {{-- additional empty rows if needed --}} @for ($j = 0; $j < 3; $j++) @endfor @endif

CWP/Water Permit No.	Source	Latitude			Longitude			Barangay Location of Source
CWP/Water Permit No.	Source	Deg.	Min.	Sec.	Deg.	Min.	Sec.	Barangay Location of Source
{{ $row['permit_no'] }}	{{ $row['source'] }}	{{ $row['deg_latitude'] }}	{{ $row['min_latitude'] }}	{{ $row['sec_latitude'] }}	{{ $row['deg_longitude'] }}	{{ $row['min_longitude'] }}	{{ $row['sec_longitude'] }}	{{ $row['barangay_source'] }}

See the Checklist Water Permit below.

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

¹ How to Determine the Water Service Provider Category

Category A

Category B

Category C

Water utilities operating for profit:

Privately-owned or privately run WUs; or
Government-owned and government-run WUs
that opted to be classified or NWRB has classified as Category A; or
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:

Are not operating for profit;
Have not expanded/ are not expanding outside their original area of jurisdiction; or
Do not opt to be classified as Category “A”/”B” or NWRB has classified as Category “A”

National Water Resources Board

APPLICATION FOR

INCREASE OF WATER RATES

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	cat_id == 'A' && $hasDocument1 ? 'checked' : '' }}>		cat_id == 'C' && $hasDocument1 ? 'checked' : '' }}>
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	cat_id == 'A' && $hasDocument2 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument2 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument2 ? 'checked' : '' }}>
Copy of approved Conditional / Water Permit/s If water is bulk supplied, copy of agreement/contract/receipt	cat_id == 'A' && $hasDocument3 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument3 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument3 ? 'checked' : '' }}>
Copy of latest Official Receipts of Annual Water Charges	cat_id == 'A' && $hasDocument4 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument4 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument4 ? 'checked' : '' }}>
Copy of latest Official Receipts of Supervision and Regulation Fee	cat_id == 'A' && $hasDocument5 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument5 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument5 ? 'checked' : '' }}>
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	cat_id == 'A' && $hasDocument6 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument6 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument6 ? 'checked' : '' }}>
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 a sketch plan is required	cat_id == 'A' && $hasDocument7 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument7 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument7 ? 'checked' : '' }}>
Copy of latest Annual Report	cat_id == 'A' && $hasDocument8 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument8 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument8 ? 'checked' : '' }}>
Latest audited financial statements	cat_id == 'A' && $hasDocument9 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument9 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument9 ? 'checked' : '' }}>
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			cat_id == 'C' && $hasDocument10 ? 'checked' : '' }}>
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)	cat_id == 'A' && $hasDocument11 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument11 ? 'checked' : '' }}>
Proposed Tariff (Downloadable form under Supplemental Guidelines in the Preparation of the Tariff Proposal)	cat_id == 'A' && $hasDocument12 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument12 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument12 ? 'checked' : '' }}>
Copy of CPC Certificate	cat_id == 'A' && $hasDocument13 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument13 ? 'checked' : '' }}>	cat_id == 'C' && $hasDocument13 ? 'checked' : '' }}>
Financial Projections Model for Category A/Category B (hard and soft copy)	cat_id == 'A' && $hasDocument14 ? 'checked' : '' }}>	cat_id == 'B' && $hasDocument14 ? 'checked' : '' }}>

{{-- 3rd PAGE Checklist Location of Service Area --}} @if ($totalBarangays >= 5)

Checklist Location of Service Area

APPLICATION FOR INCREASE OF WATER RATES - {{ strtoupper($application->applicant_name) }}

@php $lastProvince = null; @endphp @foreach ($tables as $table) @if ($table['province'] !== $lastProvince)

PROVINCE : {{ $table['province'] }}

@php $lastProvince = $table['province']; @endphp @endif @foreach ($table['columns'] as $col) @endforeach @foreach ($table['columns'] as $col) @endforeach @foreach ($table['municipalities'] as $m) @endforeach

Subdivision	{{ $col['subdivisions'] }}
Barangay	{{ $col['barangay'] }}
Municipality	{{ $m['value'] }}
Province	{{ $table['provinceCell']['value'] }}

@endforeach

@endif @if ($rowPermit > 4)

Checklist Water Permit

APPLICATION FOR INCREASE OF WATER RATES - {{ strtoupper($application->applicant_name) }}

@foreach ($rowsData as $row) @endforeach

CWP/Water Permit No.	Source	Latitude			Longitude			Barangay Location of Source
CWP/Water Permit No.	Source	Deg.	Min.	Sec.	Deg.	Min.	Sec.	Barangay Location of Source
{{ $row['permit_no'] }}	{{ $row['source'] }}	{{ $row['deg_latitude'] }}	{{ $row['min_latitude'] }}	{{ $row['sec_latitude'] }}	{{ $row['deg_longitude'] }}	{{ $row['min_longitude'] }}	{{ $row['sec_longitude'] }}	{{ $row['barangay_source'] }}

@endif