GOVERNMENT OF MEGHALAYA

PUBLIC HEALTH ENGINEERING DEPARTMENT

FORM NO.PHE. W.2

APPLICATION FOR PRIVATE OR BULK WATER SUPPLY CONNECTION

(To be filled by Applicant)

Please ensure you have following enclosures before proceeding to apply

1. Driving License/Voter Id/Adhaar Card/Passport (mandatory) *

2. Land Holding Certificate (mandatory) *

3. Residential Certificate from DC/SDO-Civil/MLA/MDC/BDO/Headman/Electricity Bill(mandatory) *

4.Photograph of the applicant(mandatory) *

Processing Location

Application Processing Location *

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Applicant’s Detail

Title

Applicant Full Name *

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Mobile Number *

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E-Mail

Upload applicant's photo(size between 20kb to 200kb) * Please upload photo of size between 20Kb to 200Kb

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Applicant Present Address

State *

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District *

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Village / Town *

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Locality *

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Nearest Landmark

Pincode

Water Connection Detail

District *

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Village / Town *

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Locality *

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Nearest Landmark

Pincode

Purpose for which connection is required *

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Type of connection *

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Size of pipe connection for domestic(Diameter Nominal DN (mm)) *

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Size of pipe connection(Diameter Nominal DN (mm)) *

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Declaration

I agree to abide by all rules and regulations in connection with water supply that may be in force from time to time.

I further certify that I am the owner/authorised representative of the premises/complex/ Institution and shall produce the necessary documents for verification on demand.

I Agree *