LEYTE V ELECTRIC COOPERATIVE, INC.

Series No:
Brgy. San Pablo, Ormoc City
Tel. No: (053)561-4075 to 4078
Cellphone No.0917-836-3895, 0998-964-3804, 0932-882-5095 OR No. / Date Issued:____________________
Website: www.leyeco-v.com.ph Email Address: info@leyeco-v.com.ph

APPLICATION FOR MEMBERSHIP AND CHANGE OF METER NAME REGISTRATION

APPLICANT (Last Name, Given Name, Middle Name)/(Company/Organization for Juridical) DATE OF BIRTH: ___/___/_____ (Month/Day/Year)

SPOUSE (Last Name, Given Name, Middle Name)

ADDRESS (House Number, Street, Sitio/Purok, Barangay, Town/City) TYPE OF MEMBERSHIP: Single Joint Juridical

Contact No: - -

REQUIREMENTS CHECKLIST:

Pre-membership Seminar (for New Consumers)

Duly accomplished & Notarized Application for Membership Form
Waiver of KWH Meter / Certification
Latest Leyeco V Electric Bill

KWH METER PROFILE OF PREVIOUS OWNER

REGISTERED OWNER: CONNECTION TYPE:
ACCOUNT NO: METER NO:

TERMS AND CONDITIONS

The undersigned (hereinafter referred to as the APPLICANT) hereby applies for membership in and agrees to purchase electric energy from LEYTE V
ELECTRIC COOPERATIVE, INCORPORATED (hereinafter called the “Cooperative”, upon the following terms and conditions:

1. The Applicant :
 Will pay to the Cooperative the sum of Five Pesos (P5.00), if such application is accepted by the Cooperative, will constitute the Applicant’s
Membership Fee.
 Upon payment of membership fee and eventually becomes a member, assumes no personal liability or responsibility for any debt or liability of the
Cooperative, and it is expressly understood that under the law his private property is exempt from execution for any debt or liability.
 Agrees to purchase electric energy from the Cooperative not later than six (6) months from the date of electric energy becomes available, and will pay
with the ERC approved rates, in accordance with the policies of the Cooperative.
 Will cause his premises to be connected in accordance with the wiring specifications approved by the Cooperative.
 Shall have all the rights and privileges granted to members under the by-laws of the Cooperative or any amendments thereof and shall comply with
and be bound by the provisions of the by-laws of the Cooperative, and such rules and regulation as may be adapted by Cooperative.
 Shall grant the Cooperative at its request the necessary rights and easements to construct, operate, replace, repair and perpetually maintain on the
property owned by the Applicant, and in or upon all roads, streets or highway abutting said property, its line or lines for the transmission or distribution
of electric energy, and will execute and deliver to the Cooperative any conveyance, grant or instrument which the cooperative will deem necessary or
convenient for said purposes or any of them. All lines of the Cooperative and switches, meters and other appliances and equipment constructed or
installed by the Cooperative on said property, except so much thereof, if any, as shall be paid for the Applicant, shall at all times be sole property of the
Cooperative, and the Cooperative shall have the rights of access to said property to operate, maintain or relocate its facilities, as may be deemed
necessary.
 Shall refrain from installing and/or operating a welding machine, compressor or other similar additional load categorized by the Cooperative and either
Commercial or industrial without prior notice and approval from the Cooperative.
 Binds to exempt the Cooperative from whatever damages or losses it may incur on account of power interruptions not within or beyond the control of
the cooperative notwithstanding the exercise of reasonable diligence to prevent such occurrence and its immediate restoration.
 Shall not be allowed to re-sell electric energy for personal profit or gain.
 Shall be held responsible and liable for tampering, interfering with or breaking any seals of meters or other equipment of the Cooperative installed on
the Applicant’s premises and/or any unlawful acts defined and enumerated under Section 2 of Republic Act No. 7832 otherwise known as the Anti-
Pilferage of Electricity, Transmission Lines / Materials Act of 1994.
 Hereby authorizes entrance to their premises by any authorized representative of the Cooperative to conduct inspection of the electrical installation,
meter reading or meter testing, as well as to confiscate any device used for violations contained in the Republic Act No. 7832.
 Will attest to the correctness of the load computation as stated in the electrical plan and in the event that any of the statements contained therein is
found to false, the Cooperative reserves the right to deny electricity to the Applicant.
 Shall be prohibited to extend its lines thru flying connection to other residence and/or establishment a distance not more than 2 meters such as (animal
pen, Store) enumerated under Section 3.5.1.2 of the Philippine Electrical Code.
2. The Cooperative
 Shall not be liable for damages caused by wiring or other accessories installed by the Applicant in his premises not in proper condition.
 Does not guarantee continuous service, but shall use reasonable diligence to provide uninterrupted service, and having used reasonable diligence
shall not be liable to Applicant, for damage, for failure in interruptions or suspension or same. The Cooperative reserves the right to suspend services
without liability on its part, at such times, for such periods, and in such manner as may in its judgment be required for the purpose of making necessary
repairs on the lines or other parts of its system.
 Is expressly authorized and empowered to remove its property and discontinue furnishing electric energy should Applicant fail to comply with any of the
terms and conditions set forth hereof and any rules and regulations of the Cooperative or become delinquent in an account due to the Cooperative.
3. The acceptance of this application by the Cooperative shall constitute an agreement between the Applicant and the Cooperative, and the contract for
electric services shall continue in force for one (1) Year from the date service is made available by the Cooperative to the Applicant, and thereafter as
long as the Applicant has need for any electric service on the subject premises.
4. That the parties hereto have agreed that this contract be deemed subject to the provisions of Republic Act No. 7832 and Republic Act no. 9136.
5. Violation or non-compliance of any of the above provisions shall constitute a ground for the termination or cancellation of membership.
The acceptance of this application shall constitute the agreement between the Cooperative and the Applicant upon the terms and condition set forth above.

___________________________________________ _______________________________________
Applicant (Signature over Printed Name) Spouse (Signature over Printed Name)
 AFFIDAVIT OF CHANGE OF METER REGISTRATION

I, _____________________________________ of legal age, Filipino & a resident of

Brgy._______________________________ respectively after having sworn to in accordance with law, do
hereby depose and say:
I, _____________________________________, a member-consumer of LEYECO V filed a change of
meter name registration of KWH Meter previously registered to __________________________________ under
the account number ___________________ and meter no. ____________________ which Leyte V Electric
Cooperative, Inc., (LEYECO V) approved said change of meter registration.

That the undersigned has filed this change of meter ownership fee of any previous obligation of whatever
from LEYECO V.

That I was executing this affidavit pursuant to existing laws, rules and regulations relative to such change
of meter registration and for whatever lawful purpose and intent this may serve.

IN WITNESS WHEREOF, I have here unto affixed my signature this _____ day of ________, 2022 at
_________________, Leyte, Philippines.

___________________________________
Affiant – Member -Consumer
(Signature over Printed Name)
CTC No:____________
Issued On:__________
Issued at:___________

SUBSCRIBE AND SWORN to Before me, this _________ day of _______________ at, Leyte
Philippines, affiants exhibited to me their Community Tax Certificates as above indicated.

NOTARY PUBLIC
 REPUBLIC OF THE PHILIPPINES
Office of the Punong Barangay
Brgy.________________________
______________________, Leyte

CERTIFICATION

TO WHOM THIS MAY CONCERN:

Old
This is to certify that Mr. /Mrs. _________________________________ previously resided in this Brgy.
And occupied a house/building with a kilowatt-hour meter with:

Account No. :

Meter No. :

Membership O.R No. :

This is to certify further that the aforementioned person is (already deceased/no longer residing in this
Barangay) and a certain Mr. /Mrs. NEW________________________________ who is known to me is the current
occupant of the abovementioned house/building.

New
This certification is issued upon the request of Mr. /Mrs. ________________________________ in
connection with his/her kilowatt-hour meter account name transfer at LEYECO V.

Done this _______ day of __________________, 20____ at Brgy. ____________________,

___________________, ____________, Philippines.

_____________________________
Punong Barangay/Kagawad

Witness:

________________________________
(Signature over Printed Name) (Signature over Printed Name)