Water Service Application - Parang Municipality

Water Service Application Form

Please fill out all required fields completely and accurately

Personal Information

Surname *

First Name *

Middle Name

Extension Name

Birthdate *

Age

Gender *

Civil Status *

Place of Birth *

Complete Address *

Location Tagging Options

You can also click directly on the map to place a marker, or drag the marker to adjust location.

Choose a location tagging method above or click on the map

City/Municipality *

Barangay *

Province *

Contact No. *

Email Address Used for application updates and billing notices

Account Details

Application No. Your application reference number

Job No. Internal job tracking number

Category *

Pipe Size

Date Applied *

Business/Establishment Name

Certification & Consent

Certification of Truthfulness
I hereby certify that all the information provided in this application is true, correct, and complete to the best of my knowledge. I understand that any false statement or misrepresentation may result in the denial of this application or the revocation of any water service granted in connection with it, and may subject me to legal action under applicable laws of the Republic of the Philippines. *

Data Privacy Consent
I hereby give my free and voluntary consent to the Local Government Unit to collect, process, store, and share my personal information for the purpose of evaluating this water service application and for related administrative, regulatory, and legal purposes, in accordance with Republic Act No. 10173 (Data Privacy Act of 2012) and its Implementing Rules and Regulations. I understand that I may exercise my rights as a data subject in accordance with the law. *

Both checkboxes are required before this application can be submitted.

Water Service Application Form

Personal Information

Location Tagging Options

Account Details

Submitted Requirements

Additional Requirements

Cedula Information

Certification & Consent