Water Services Industry Act 2006

Form QT 1 P.U. (A) 36 Page 1 of 2

SIXTH SCHEDULE [Subrule10(1)]

WATER SERVICES INDUSTRY ACT 2006

WATER SERVICES INDUSTRY (WATER RETICULATION AND PLUMBING) RULES 2014

APPLICATION FOR TEST AND INSPECTION OF EXTERNAL WATER RETICULATION SYSTEM / SUPPLY MAIN* (For Demand <50,000 liter per day / >50,000 liter per day*)

Dat : e

To : Chief Executive Officer, SuruhanjayaPerkhidmatan Air Negara Address : File No. : Development : Title

I/We refer to the approval of plans, designs and specifications for the implementation of an external water reticulation system/supply main* for the above named development as notified by SuruhanjayaPerkhidmatan Air Negara on …………………………….

2. In accordance with rule 10 and the Sixth Schedule of the Water Services Industry (Water Reticulation and Plumbing) Rules 2014, I/We hereby apply for [material and pipe inspections, for pressure and leakage tests/for supervision of tapping connection, for sterilization, dewatering, flushing and water quality testing activities/for inspection, testing and commissioning of mechanical and electrical works/and final inspection for handover of facilities to the water distribution licensee],* and we submit herewith a cheque for the sum of RM……………………… payable to ……………………………..(name of water distribution licensee) for …………………………….(name of water distribution licensee) to conduct the said inspections, supervisions and tests.

3. Notification shall be issued to your office when preparations to carry out the aforesaid inspection, supervisions and tests have been completed.

……..……………………………..

Signature of developer

Form QT 1 File : P.U. (A) 36 No. Page 2 of 2

Name of developer (in capital letters):

NRIC no. : Address : Developer License no : Designation : Date :

(*Delete whichever is not applicable)