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Membership Application Form

Zamcelco

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Lovely Padz
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33 views2 pages

Membership Application Form

Zamcelco

Uploaded by

Lovely Padz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR MEMBERSHIP

The undersigned, herein after called the “APPLICANT” hereby applies for membership in
the Zamboanga City Electric Cooperative, Inc., hereinafter referred to as the
“COOPERATIVE”, and in consideration for acceptance of this application do hereby state
the following:

NAME OF APPLICANT
_____________________________________________________________
(Family Name) (First Name) (Middle Name)

COMPLETE ADDRESS
_____________________________________________________________
House No. Street/Sitio Barangay City/Municipality

CIVIL STATUS: _________________ NAME OF SPOUSE (if married): _____________________________


Date of Birth: __________________ Place of Birth: ________________________________
CONTACT NO.: E-MAIL ADDRESS:

FOR SPOUSE

Date of Birth: Place of Birth:

TYPE OF MEMBERSHIP TYPE OF OWNERSHIP TYPE OF CONNECTION

Single [ ] Joint [ ] House Owner [ ] Tenant [ ] Residential [ ] Commercial [ ]

CON from: ________________________________


Mem Fee OR No.: __________________________
A/N: ______________________________________
Date Paid: _________________________________
E/D Fee: __________________________________

Attach 2 Attach 2
copies of 1x1 copies of 1x1
ID picture ID picture

_____________________________ __________________________
Signature of PRIMARY MEMBER Signature of JOINT MEMBER
TERMS AND CONDITIONS
1. The APPLICANT will pay to the COOPERATIVE the sum of P5.00 which, if this application is
accepted by the COOPERATIVE, will constitute the Applicant’s membership fee;
2. The APPLICANT will when electric energy becomes available, purchase from the
COOPERATIVE, all electric energy used on the praises and will pay therefore monthly rates to
be determined from time to time in accordance with the law and policies, rules, regulations
and resolutions of the Cooperative;
3. The APPLICANT will cause his/her premises to be wired in accordance with specifications
approved by the COOPERATIVE;
4. The APPLICANT will comply with and be bound by the provision of the Charter and By-laws of
the COOPERATIVE and such policies, resolutions, rules and regulations as may, from time to
time, be adopted by the Cooperative;
5. The APPLICANT, by paying the membership fee and becoming a member assumes no
personal liability or responsibility for the debts or liabilities of the COOPERATIVE;
6. The undersigned will grant to the COOPERATIVE, at its request, the necessary rights and
easements to construct, operate, replace, repair and perpetually maintain, on the property
owned by the undersigned, its lines for the transmission or distribution of electric energy, and
will execute and deliver to the Cooperative an conveyance, grant or instrument which the
Cooperative shall deem necessary or convenient for said purpose or any of them. All lines of
the Cooperative and switches, and other appliances and equipment constructed or installed
by the Cooperative on said property shall at all times be the sole property of the Cooperative,
and the Cooperative shall have the right of access to said property to operate, maintain or
relocate its facilities;
7. The COOPERATIVE shall not be liable for damages to the APPLICANT for failure to supply
electricity to said premises and/or any fluctuations thereof under any conditions and;
8. To allow employees and/or representatives of the COOPERATIVE to enter my premises without
being liable to trespass to dwelling for the purpose of collecting payment of electric bills,
disconnecting service, inspecting, installing, reading, replacing or otherwise disposing off its
apparatus;
9. The acceptance of this application by the COOPERATIVE shall constitute an agreement
between the APPLICANT and the COOPERATIVE. The agreement shall continue to be in force
for one (1) year from the date service is made available by the Cooperative to the Applicant
until cancelled and/or revoked by either party by giving SIXTY (60) DAYS prior notice;
10. All annexes/attachments hereto are integral parts hereof and shall bind the APPLICANT.

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