C.F No.22

Cost of Form Rs.10/-

No.

To

The Commissioner,
Coimbatore Corporation.

Sir,

I / We wish to inform that the following water supply house service connection is of my / house. Hence I / We request you to transfer the service connection in my / our name.

Details of Water Supply House Service Connection:

1. House Service Connection Assessment No: 

2. In whose name the house service connection at present:

3. To whom name the house service connection to be transferred?

4. Whether the house service connection is under Domestic / Non-Domestic use

5. Door No:

6. Ward No. and Name of street:

7.Property tax name transfer order no & date:

8. If the name transfer order not available basis under which the transfer is requested:

9. Whether the water charges paid in full without arrears up to the last meter reading:

10. Name of the applicant with address:

AFFIDAVIT

1. I / We assure that I / We will abide by the rules and pay that water charges regularly by using my / our house service connection continuously.
2. I / We assure that I / We will abide by the rules and regulations framed under water supply laws and Coimbatore City Municipal Corporation Act, 1981.
3. I / We assure that the water supplied through my / our house service connection will not be supplied to others and also misused to other purposes as per water supply rules.
4. I / We also certified that the particulars furnished in this applications are true to the best of my / our knowledge.

Signature of the Applicant