<p> Form QT 1 P.U. (A) 36 Page 1 of 2</p><p>SIXTH SCHEDULE [Subrule10(1)]</p><p>WATER SERVICES INDUSTRY ACT 2006</p><p>WATER SERVICES INDUSTRY (WATER RETICULATION AND PLUMBING) RULES 2014</p><p>APPLICATION FOR TEST AND INSPECTION OF EXTERNAL WATER RETICULATION SYSTEM / SUPPLY MAIN* (For Demand <50,000 liter per day / >50,000 liter per day*)</p><p>Dat : e </p><p>To : Chief Executive Officer, SuruhanjayaPerkhidmatan Air Negara Address : File No. : Development : Title</p><p>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 ……………………………. </p><p>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. </p><p>3. Notification shall be issued to your office when preparations to carry out the aforesaid inspection, supervisions and tests have been completed.</p><p>……..……………………………..</p><p>Signature of developer</p><p>Form QT 1 File : P.U. (A) 36 No. Page 2 of 2</p><p>Name of developer (in capital letters):</p><p>NRIC no. : Address : Developer License no : Designation : Date :</p><p>(*Delete whichever is not applicable)</p>