CTG WASA

DeepTubewell Application - Form

Applicant / Company

Father/ Spouse

On behalf of

Applicant's Addr.

Company Type

NID/ Passport/ Birth Certificate No.

NID Passport Birth Certificate (Choose any one)

Mobile No

Email

Com. Chief

Chief Desig.

Con. Date

Location

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Holding No

Area Name

Zone Name

Mowja Name

Is CDA approved?

Daily Water Demand

Water Use Type

Tubewell Dimension

Installation Date

RS Ledger No

BS Ledger No

RS Mark No

BS Mark No

Pump Type

Pump Use Duration

TubeWell Deepness

Approx Installation Date

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SL	A/C No	Con. Dimention	Con. Date	Due Tax	Remarks
#01
#02

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Applicant Photo

NID/ Passport/ Birth Certificate

BS Khatiwan

BS Mark No

CDA Approved Plan

Limited Comany Document

Deed & Other Doc