METER DEPOSIT REFUND

APPLICATION FORM
(For Active Contracts)
\ Service Identification Number (SIN): _________________________
Registered Customer Legal Heir Successor-in-Interest

Date: ____________________

CLAIMANT INFORMATION The claimant shall refer to the Registered Customer (RC), Legal Heir if RC is deceased or Successor-in-Interest. Claimants Name Please indicate if claimant is the: Contact Information Service Address Representative (If Applicable) Relationship to Customer Contact Information

REFUND INFORMATION Mode ( ) Refund in Cash or Check Cash ( P4000) Check (> P4000) ( ) Application to Unpaid Bills, Net Amount for Refund, if any Cash ( P4000) Check (> P4000) ( ) Credit to Future Bills (Pre-Payment) ADDITIONAL INFORMATION if service is subject to a Creditable Withholing Tax (CWT) on Interest Following the provisions of BIR Revenue Regulation No. 2-2009,
Residential and General Service customers whose monthly electricity consumption exceeds 200 kWh as classified by Meralco and all Non-Residential Service customers are subject to a CWT on Meter Deposit Interest.

Tax Identification Number (TIN):

Mailing Address: This shall refer to the address where the Claimant prefers to receive correspondences.

__ __ __

House/Bldg no.

Street Name

__ __ __ __ __ __ __ __ __ STATEMENT OF INTENT

Subdivision/Barangay

City/Municipality

ZIP Code

I hereby apply for a refund of my Meter Deposit under my electric service contract with the above-stated Service Identification Number (SIN). I understand and agree that the amount to be received/applied to my unpaid obligation and/or future billings represents the principal amount of my meter deposit and accrued interest, net of Creditable Withholding Tax (CWT) if applicable. I attest to my right and/or authority to claim the refund, and I agree to hold Meralco free and harmless from any and all liabilities arising from or in connection with the Meter Deposit upon payment to me or my authorized representative of the refund amount due. I undertake to return the amount received or any portion thereof if shown in the future to be erroneous or due to another person or entity. I hereby certify that all information provided and documents submitted in support of my application for refund are true, correct and complete. I further attest that I have personally signed this form or the signature appearing herein is authorized and authentic. By: _____________________________________________
Signature over Printed Name Registered Customer/Legal Heir/Successor-in-Interest*
* An Authorized Representative may be allowed to sign this application form in behalf of the Registered Customer/Legal Heir/Successor-in-Interest, provided that a duly Notarized Special Power of Attorney (SPA) is submitted.

DO NOT FILL OUT FOR MERALCO USE ONLY

Requirements Submitted/Presented
( ( ( ( ) ) ) ) Original Meter Deposit Receipt Declaration of Loss Notarized Affidavit of Loss Valid ID of Registered Customer/Legal Heir/Successor-in-Interest If Representative
( ) Authorization Letter ( ) Notarized Special Power of Attorney ( ) Valid ID of Authorized Representative

Refund Mode
( ) Refund in ( ) Cash ( ) Check ( ) Application to Unpaid Bills, Net Amount for Refund in ( ) Cash ( ) Check ( ) Credit to Future Bills (Pre-Payment)

If Successor-in-Interest
( ) Proof of Transfer of Rights/Ownership

If Subject to CWT
( ) TIN Card ( ) BIR Certificate of Registration ( ) BIR-issued Tax Exemption Certificate

If Legal Heir
( ( ( ( ( ) ) ) ) ) Death Certificate* of the Deceased Registered Customer Birth Certificate* Marriage Certificate* Undertaking that there are no other Legal Heir/s Extra-Judicial Settlement of Estate*

Others (please specify):

REMARKS
( ) OK for Refund ( ) Refer to MDR Help Desk ( ) Others ____________ __________________

RECOMMENDED BY:
____________________________

APPROVED BY:
______________________________

REFUND STUB CUSTOMER NAME:___________________________________

SIN:_____________________

You may claim your Meter Deposit Refund on _________________________________, at any time between 8:00 AM and 5:00 PM. PLEASE BRING THE ORIGINAL AND PHOTOCOPY OF YOUR VALID ID. By: _____________________________________________
Signature Over Printed Name of Meralco Representative/Date

Rev02_11/09