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Name :
Address :
Date of Birth : :
Code Number : Account Number :
Φ The account must be registered to the senior citizen for the period of 1 year;
Φ Shall be applied and renewed every year thereafter;
Φ Discount shall apply to residential accounts only and shall be granted per
household regardless of the number of senior citizens residing therein;
Φ In case the senior citizen has multiple accounts, only the account where
he/she resides shall be entitled to the discount;
Φ A 5% fixed discount on monthly water bill shall be granted provided it does not
exceed 30 cum.
I HEREBY UNDERSTAND AND AGREE to the terms & conditions above.
Date :
NEW RENEWAL
Documents Submitted: If applying through a representative:
Senior Citizen Discount Application Form Authorization Letter
Recent 2 x 2 Picture Valid ID of Representative
Photocopy of Valid OSCA ID Picture of Senior Citizen
Proof of Residence/Barangay Clearance holding latest newspaper
Other ID presented
Evaluated by: Approved by:
ANNAFE COLLAO-PATO ENGR. PAULINO S. CUNANAN
FCSD Division Manager C General Manager
Date : Date :
PILI WATER DISTRICT
Sta. Rita Agro-Industrial Park
San Jose, Pili, Camarines Sur
APPLICATION FORM FOR SENIOR CITIZEN DISCOUNT
(to be filled up by PIWAD personnel)
OSCA ID Number
WATER CONNECTION ACCOUNT DATA
CONDITIONS FOR THE AVAILMENT OF SENIOR CITIZEN DISCOUNT
name & signature
SENIOR CITIZEN PERSONAL DATA
FCSD-CSD 003
August 2017 Rev. 00

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Senior citizens-discount

  • 1. Name : Address : Date of Birth : : Code Number : Account Number : Φ The account must be registered to the senior citizen for the period of 1 year; Φ Shall be applied and renewed every year thereafter; Φ Discount shall apply to residential accounts only and shall be granted per household regardless of the number of senior citizens residing therein; Φ In case the senior citizen has multiple accounts, only the account where he/she resides shall be entitled to the discount; Φ A 5% fixed discount on monthly water bill shall be granted provided it does not exceed 30 cum. I HEREBY UNDERSTAND AND AGREE to the terms & conditions above. Date : NEW RENEWAL Documents Submitted: If applying through a representative: Senior Citizen Discount Application Form Authorization Letter Recent 2 x 2 Picture Valid ID of Representative Photocopy of Valid OSCA ID Picture of Senior Citizen Proof of Residence/Barangay Clearance holding latest newspaper Other ID presented Evaluated by: Approved by: ANNAFE COLLAO-PATO ENGR. PAULINO S. CUNANAN FCSD Division Manager C General Manager Date : Date : PILI WATER DISTRICT Sta. Rita Agro-Industrial Park San Jose, Pili, Camarines Sur APPLICATION FORM FOR SENIOR CITIZEN DISCOUNT (to be filled up by PIWAD personnel) OSCA ID Number WATER CONNECTION ACCOUNT DATA CONDITIONS FOR THE AVAILMENT OF SENIOR CITIZEN DISCOUNT name & signature SENIOR CITIZEN PERSONAL DATA FCSD-CSD 003 August 2017 Rev. 00