GALL-UU TAL-UFFIJUFOR OFFICE USE ONLY

Numru ta notifikaNotification number

Sezzjoni A / Section A

1. Numru tal-kont/Account Number

Dettalji ta Sid il-Kont /Account Holder Details Kunjom/Surname2. (a) Isem u kunjom

Name and surname Isem/Name

(b) Numru tal-Karta tal-Identit Identity Card Number

(c) Mobajl / Telefon Mobile / Telephone

Numru jew isem tal-fond/Number or name of premises

(d)Indirizztafejniridjitneais-servizz Address from where service is to be removed Triq/Street

Lokalit/Locality Kodii Postali/Postcode

Dettalji tal-persuna li ser tifta il-postDetails of person who will provide access Kunjom/Surname3. (a) Isem u kunjom

Name and surname Isem/Name

(b) Mobajl / Telefon Mobile / Telephone

Numru jew isem tal-fond/Number or name of premises

(c) Indirizz postali Postal address Triq/Street

Lokalit/Locality Kodii Postali/Postcode

Sezzjoni B / Section B1. Galxiexqedjintual-post Residenzjali Non-Residenzjali Purpose for which premises is used Residential Non-Residential

2. Numru tal-kont (jekk japplika) Account Number (if applicable)

3. Numru tal-meter tal-Ilma / Water meter number

Applikazzjoni gat-tneija tas-servizz tal-IlmaApplication for removal of water service

C

www.smartutilities.com.mt

ARMSLtd.-P.O.Box63,Marsa,MRS1000,Maltacustomercare@arms.com.mt

AVVI DWAR IL-PRIVATEZZA TAL-INFORMAZZJONIL-informazzjoni personali mibura fdin il-formola ser tii pproessata minn ARMS Ltd fisem il-Korporazzjoni gas-Servizzi tal-Ilma u l-Korporazzjoni Enemalta. Dan l-ipproessar ser isir bkunfidenzjalita` u gall-iskop sabiex jinaru u jintbagtu l-kontijiet gas-servizzi pprovduti mill-korporazzjoni rispettiva. Gandek id-dritt li taessa, tibdel, u fejn huwa applikabli, tassar l-informazzjoni li tikkonernak. ARMS Ltd tigura li l-informazzjoni personali dwarek tii pproessata bmod rett. Id-dettalji tiegek jistgu jiu wati minn ARMS Ltd sabiex jintbagtu messai ta promozzjoni fuq servizzi li, minn mien gall-mien, il-kumpanija tibgat. Jekk ma tixtieqx li tirievi dawn il-messai, inti mitlub/a sabiex tinfurmana bil-miktub fl-indirizz li jidher hawn fuq.

DATA PROTECTION NOTICEThe personal data contained in this application form shall be processed by ARMS Ltd on behalf of Water Services Corporation and Enemalta Corporation in strict confidentiality and for the purpose of billing you for the services rendered by the respective corporation. You have the right to access, rectify, and where applicable, erase any data concerning you. ARMS Ltd guarantees fair processing of your personal data. Your contact details may be used by ARMS Ltd to send marketing communications regarding the services which the organisation may, from time to time, promote. Should you wish not to receive such communications, you are being requested to inform us in writing at the address indicated above.

Sezzjoni /Section CData tal-qari tal-arlo / / Date of meter reading dd mm yyyy

Qari tal-meter tal-ilma / Water meter reading

Numru tal-meter tal-ilma / Water meter number

1. JekkgandeksistemaFotovoltajkainstallatafil-fond tiegek,jekkjogbokimlasezzjoni2minflokdinis-sezzjoni If you have a Photovoltaic system installed at your premises, please fill section 2 below instead of this section

Qari tal-meter tal-Elettriku / Electricity meter reading

Numru tal-meter tal-Elettriku / Electricity meter number

2. ImlaBISSdinis-sezzjonijekkgandeksistemaFotovoltajkainstallatafil-fondtiegek Fill in this section ONLY if you have a Photovoltaic system installed at your premises

Numru tal-meter tal-Elettriku / Electricity meter number

Qarital-metertal-Elettriku(Export) / Main Electricity Meter Reading (Export)

Qari tal-meter tal-Elettriku (Import) / Main Electricity Meter Reading (Import)

Numru tal-Meter tal-PV / PV Meter Number

Qari tal-Elettriku tal-PV / PV Electricity Reading

Sezzjoni D /Section D1. Kopja tal-Karta tal-Identit tal-applikant.

Copy of Identity Card of the applicant. 2. It-tneijatal-metertal-ilmahijabxejn./Water meter removal is free of charge.3. Applikazzjonijietminnpersunilijkollhomdejngadupendentifuqil-konttaghommajiuxaettati.

Applications from persons who have outstanding debts on their accounts will not be accepted.4. Ikunmetieapplikazzjonididaud-dokumentazzjonirelevantiflimkienmal-miatarispettivametajitwaalmill-didmeterli

kientneafuqtalbatasidil-kont,jewmembrutal-familjatiegu/taghafkalisidil-kontikunmejjet.A new application together with all relevant documentation plus the respective fee shall be required for the reinstatement of a meter where such a meter has been previously removed at the demand of the account holder, or of a member of his/her family in the event of decease of the account holder.

5. Jekksidil-konthuwamejjet,provalil-persunaliqiegdatapplikahijasidid-darhijametiea.L-applikantjistajissottomettidikjarazzjonitan-nutarlihuwasidil-fond,jewjipprovdiprovaorabalkopjatal-wirt.Fejnhemmijedminwerrietawada,firmamill-werrietakollha,jewdikjarazzjonimin-nutar,lil-werrietaqedjaqblulijittneas-servizztal-ilma,huwametie.In the case that the account holder is deceased, the applicant needs to provide proof of ownership of the said premises. The applicant may submit a notary declaration, or any other proof such as a copy of the will. In the case of more than one property owner, a signed authorisation from all owners, or a notary declaration, declaring that all owners agree to the removal of the water service, is required.

Sezzjoni E /Section EJienhawntatiffirmatqiegednapplikagat-tneijatal-provvistatal-ilmatatil-kundizzjonijiethawnfuqimsemmija,uskondir-Regolital-Provvistatal-Ilma.I, the undersigned, hereby apply for the removal of water supply in accordance with the conditions mentioned in this application, and in accordance to the Water Supply Regulations.Is-servizzgat-terminitadinl-applikazzjonigandujingataskontil-leilazzjonipertinentiumingajrebdapreudizzjugad-drittijiettat-terzi.L-applikantjidolresponsabbli gall-eattezza u l-verit tal-informazzjoni pprovduta u kull ineattezza gandha tkun suetta gat-termini tal-liijiet taMalta, u bala riultat,fostaffarijietora, jista jkunhemmsospensjoni tas-servizzu / jew jittiedupassiudizzjarji fil-Qorti.L-applikant jikkonferma liqed jifhemdin id-dikjarazzjoniul-konsegwenziliorrmaghaujaqbelbis-siublariservamal-kontenuttagha.The service in terms of this application shall be furnished in accordance to the pertinent legislation and without any prejudice to third party rights. The applicant is fully responsible for the accuracy and for the truthfulness of the information provided and any inaccuracy shall be dealt with in terms of the laws of Malta and shall result, amongst others, in the suspension of the supply and/or in the institution of judicial proceedings. The applicant confirms that he understands this declaration and the consequences thereof and agrees entirely and without reservation with its contents.

Firma/Signature Data/Date

Applikazzjoni gat-tneija tas-servizz tal-IlmaApplication for removal of water service

ACC502/31x29/11

www.smartutilities.com.mt

ARMSLtd.-P.O.Box63,Marsa,MRS1000,Maltacustomercare@arms.com.mt