NWRB-WUD-12-r3

Republic of the Philippines APPLICATION FOR

NATIONAL WATER RESOURCES BOARD INCREASE OF WATER RATES
8th Floor NIA Building, EDSA, Quezon City
Telefax (02) 8920-2714 Water Service Case Number
Accomplish this form in six (6) copies. Provider (WSP)
Attach separate sheet if more space is required. Category1
Name of Applicant Mailing Address Email Address

Contact No.

Citizenship TIN Year Operations Started

Provisional Authority Required? Filing Fee Amount OR No. Date Paid
 Yes  No
Location of Service Area
Subdivision

Barangay

Municipality
Province
Type of Water Service Provider Number of Connections Kind of Water System
 Subdivision / Homeowners’ Association With water meters ___________  Draw and Fill
 Rural Waterworks and Sanitation Without water meters ___________  Float
Association Meters tested?  Direct Pumping
 Cooperative  Yes  No For Bulk Water Seller/Peddler,
 Bulk Water Seller / Peddler If tested, Average volume of water delivered per day
 Others, specify: Tested by _________________ (in cu. m.)
__________________________________ Date tested _________________
Water Permit Information
Latitude Longitude
CWP/ Water Permit No. Source 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 Subscribed and sworn to before me on this date:
submitted are true and correct to the best of my knowledge and belief.

____________________________________________________ ______________________________________ _____________

Signature over printed name of Water Utility Representative 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: Government-owned or controlled, and Community-based WUs that:
1. Privately-owned or privately run WUs; or government-run WUs that do not opt 1) Are not operating for profit;
2. Government-owned and government-run WUs to be classified as Category “A” or 2) Have not expanded/ are not
that opted to be classified or NWRB has classified NWRB has classified as Category B expanding outside their original area
as Category A; or of jurisdiction; or
3. Community-based WUs that: 3) Do not opt to be classified as
a) Have expanded/ are expanding outside Category “A”/”B” or NWRB has
original area of jurisdiction, or classified as Category “A”
b) Opted to be classified or NWRB has classified
it as Category A
 National Water Resources Board
APPLICATION FOR
INCREASE OF WATER RATES
Name of Applicant Water Utility Category Case Number

Cat. Cat. Cat.

Documentary Requirements
A B C
1 Articles of Incorporation/Partnership or DTI/CDA Registration  
Authority to sign and file the application
2 • 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
3
If water is bulk supplied, copy of agreement/contract/receipt
  
4 Copy of latest Official Receipts of Annual Water Charges   
5 Copy of latest Official Receipts of supervision and Regulation Fee   
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
6
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
7 • 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
8 Copy of latest Annual Report   
9 Latest audited financial statements   
10 Simplified Financial Projections Model for Category C (hard/soft copy) with the
following data:
• Revenue requirements for one year, composed of:
o Operating expenses, with breakdown   

o Depreciation
o Loan amortization (interest and principal) per year
• Estimated total consumption for one year in cu.m.
11 Business Plan containing:
• List of existing/required investment 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)
Proposed Tariff (Downloadable form under Supplemental Guidelines in the Preparation
12
of the Tariff Proposal)
  
13 Financial Projections Model for Category A/Category B (hard and soft copy)   