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Registration Form for Domestic User
NWRB application form for domestic user
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REGISTRATION
Republic of the Philippines
WATER USE NO. __________
NATIONAL WATER RESOURCES BOARD
8th Floor, NIA Building, EDSA, Quezon City Filed in the Office of the
On this date _______________
1. Name of Water User
2. Mailing Address
3. Citizenship
4. Starting Date of Water Use
5. Name of Water Source
6. Method of Diversion
Well
Spring
River
Others (specify)
7. Location of Water Source
Latitude:
Longitude:
Pump (______ hp)
Gravity
Others (Specify)
8. Water Appropriated in
_________ liters/second
_________ gallons/day
_________ drums/day
_________ others (Specify)
9. Period of Water Use
10. Purpose: ( e.g. domestic, commercial,
industrial) If domestic – No. of persons per household.
I hereby certify that the information given
above and the documents submitted are
true and correct to the best of my
knowledge and belief.
Subscribed and sworn to before me on
this date:
_______________________
Signature of Water User
_________________________
Administering Officer
