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Water & Sewerage Support - New Connections Form

Connection Information
WATER & SEWERAGE CORPORATION
CUSTOMER SERVICES DEPARTMENT
SERVICE REQUEST FORM
“COMMITTED TO GROWTH, COMMITTED TO QUALITY”
APPLICATION AND AGREEMENT FOR WATER SUPPLY/AND/OR CONNECTION TO SEWERS
By this application, I/we, the owner(s) or agents of the owner(s), hereby contract with the Water and Sewerage Corporation, hereinafter called the Corporation, to supply the following services at the service address shown below. We further agree to abide by the laws, regulations and/or policies governing the Corporation. It is noted that upon failure to make payments on this account within six (6) months or more, the Corporation reserves the right to apply my service deposit to my outstanding balance, and refund any credits due to me resulting there from, should the assigned account be finalled and closed.
Supply Water For Domestic/Commercial Purposes
Connect Sanitary Fixtures And Drainage To The Sewer System
THE ADDRESS OF THE PREMISES TO BE CONNECTED IS AS FOLLOWS:
Lot No  House/Bldg No  Apt/Unit No 
Street  Subdivison  Permit No 
Phone 
Other Directions 
Premises Are:
Under construction       Under renovation 
Ready for occupancy    Occupied
If Unoccupied, Projected Occupancy Date 
Premises Usage
PREMISES WILL BE USED FOR
 Single Family Dwelling and number of bathrooms  
 Apartments with total number of units    and total number of bathrooms 
 Hotel/guest house with total number of rooms  
       and number of clubs/restaurants/bar 
 Restaurant / club / bar with total number of seats  
      and number of bathrooms 
 School with total number of students  
 Laundry with total number of machines  
 Commercial building with total number of occupants  
       and number of bathrooms 
 Other (specify)  
Fixture Insallations
THE NUMBER OF FIXTURES INSTALLED/TO BE INSTALLED AT THESE PREMISES IS AS FOLLOWS:-
FIXTURE TYPE NUMBER
Bathtub with/without shower head
Bidet
Shower, stall, domestic
Dishwasher, domestic
Dishwasher, commercial
Automatic clothes,washer
Lavatory with small pipe plug outlet
Lavatory with large pipe plug outlet
Lavatory (barber, beauty parlor)
Laundry tray (l or 2 compartments)
FIXTURE TYPE NUMBER
Kitchen, sink, domestic
Kitchen, sink, domestic with food grinder
Service sink, combination trap standard
Janitor service sink, trap ordinary
Wash sink (circular or multiple) each set of faucets
Urinal
Water closet, tank operated
Water closet, valve operated
Floor drains
TERMS/CONDITIONS

TENANTS MAY APPLY UPON SUBMITTING WRITTEN AUTHORIZATION FROM THE OWNER – FORM CS009(a). RECEIPTS ARE YOUR EVIDENCE OF PAYMENT. A SERVICE ORDER FOR INSTALLATION OF SERVICE WILL NOT BE ISSUED UNTIL PAYMENT IS RECEIVED.

Applications are to be submitted by the owner(s) or his/her agent, or a tenant in whose name the lease or rent receipt appears. If acting as agent, the application should be accompanied with a notarized power of attorney or written authorization in their favor from the owner(s). The owner(s)/tenant(s) are required to bring in proof of identification, i.e. valid PASSPORT (s), and NATIONAL INSURANCE CARD (s).

In case of joint ownership, all owners e.g. husband and wife or their authorized agent must sign.

In case of tenants, the application must be accompanied by copy of the lease and/or proof of payment of rents or deposit.

In case of Limited Company, the application must be signed by two or more directors of the Company.

In case of a church, not for profit or similar association, at least two trustees must sign.

1.   I/we agree to pay all lawful charges in respect of installation of the water and/or sewer service connection(s) including such road reinstatement charges as may be assessed by the Corporation. I/we further agree to pay the appropriate service deposit, and such additional deposits/charges as may be required at a later date.
2.   I/we agree to comply, in full, to all Rules and Regulations in force, governing water supply and waste water sanitation, and to any regulations made hereafter by the Water and Sewerage Corporation. To this end, I/we agree to employ a Licensed Plumber, and submit a certificate from him to the effect that rules and regulations governing house sanitation have been complied with, before permission to connect to the street sewer is granted. I/we further agree, in the event the water pipework fittings, equipment, appliances and the like on the property are not fully in accordance with the above mentioned Regulations, to have all necessary repairs, replacements, medications and alternations carried out by a Licensed Plumber.
3.   I/we enclose herewith a diagram showing the plumber’s recommended location of water meter and/or sanitary drainage line to the street sewer for consideration and approval by the Corporation.
4.   In relation to 2 above, I/we agree to maintain such pipe work, fitting, equipment, appliances and the like, in good and fully satisfactory order and condition and in full compliance with all Regulations in force.
5.   I/we undertake to pay the Corporation for all water registered by the installed meter and subsequent meter(s) as may be connected to the supply line and/or such minimum charges as may be fixed for supply and/or such charges that may be assigned to sanitary fixtures at the rates and charges now fixed or which may hereafter be fixed by the Corporation.
6.   I/we fully understand and agree that the Corporation is not and will not be in any way responsible for any defect, waste, misuse or pollution of water after it has passed through the meter and I/WE further agree to accept full liability for all quantities of water registered by the meter regardless of tenancy of premises.
7.   I/we affirm that as owner(s)/authorized tenants of the property, we accept responsibility for all matters associated with the establishment of the account.
8.   Allow 48 hours for the application to be processed and for Customer Services staff to notify you of the applicable charges.
9.   Allow an additional ten (10) workings days from receipt of payment for your connection(s) to be made.
10.   Cash, certified cheque or credit card payments accepted. Personal cheques are accepted from customers with existing accounts in good credit standing only.
 
Personal Data Owner/Agent Tenant
Applicant Surname    First Name    Middle Name  
Nat'linsurance#   Passport#   P.O.Box#  
Email      
Mortgage Holder/Bank Reference#   Branch#  
CO-Applicant’s Surname    First Name    Middle Name  
Nat'linsurance#   Passport#   P.O.Box#  
Workplace#   Workphone#   Homephone#  
Additional Contact Person (required if there Is no co-applicant)
Surname    First Name    Middle Name  
Workplace#   Workphone#   Homephone#  
I/we hereby affirm that all information provided is, to the best of our knowledge, both true and correct and authorize you to contact the reference (s) cited above for further information to support this application.
Date
Applicant's Signature
Co-Applicant's Signature
Company Director (1)
Company Director (2)
Trustee (1)
Trustee (2)
Additional Information
THE CORPORATION DOES NOT ACCEPT APPLICATIONS FROM TENANTS. RECEIPTS ARE EVIDENCE OF PAYMENT. A SERVICE ORDER FOR INSTALLATION OF SERVICE WILL NOT BE ISSUED UNTIL PAYMENT IS RECEIVED.
Applications are to be submitted by the owner(s) or by their agent. The latter should attach a notarized power of attorney or written authorization in their favour from the owner (s).
An application must be FULLY COMPLETED BEFORE SUBMISSION TO THE CORPORATION and supported by proper documents to verify ownership as Follows:
1. A COPY OF TITLE DEED (LAND PAPERS/CONVEYANCE) OR
2. LETTER FROM THE BANK/INSURANCE COMPANY INDICATING THAT MORTGAGE IS HELD AGAINST PROPERTY OR
3. IF NEITHER OF THESE DOCUMENTS IS AVAILABLE,AN AFFIDAVIT FROM A JUSTICE OF THE PEACE IS ACCEPTABLE
In case of joint ownership, and owners e.g. husband and wife or their authorized agent must sign.
In case of Limited Company, the application must be signed by two or more directors of the Company accompanied by a copy of the resolution authorizing these directors to sign on behalf of the company. An article of association and certificate of good standing must also be attached.
In the case of a church, not for profit or similar association, at least two trustees must sign.
Allow five working days for the application to be processed and for Customer Services staff to notify you of the applicable charges.
Allow an additional fifteen working days from receipt of payment for your connection (s) to be made.
Cash, certified cheque or credit card payments accepted. Personal cheques accepted from customers with existing accounts in good credit standing.
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