BILL FORMAT IN USE AT PRESENT
ANNEXURE V
GOVERNMENT OF GOA, BANK/OFFICE COPY AND CONSUMER COPY
PUBLIC WORKS DEPARTMENT LAST DATE OF PAYMENT
DIV. SUB.DIV. BILL NO. ISSUE DATE FROM DATE AVG UNITS
CURRENT FAULT
METER
READING PREVIOUS
METER NO. METER SIZE METER FIX DATE TO DATE MIN DATE
SEC. DEPOSIT
ADDITIONAL UNITS
BILLED WATER
CHARGES METER RENT
SEWAGE CHARGES
ARREARS (CREDIT)
RECEIPT NO. DATE CHEQUE NO. DATE TOTAL
RUPEES……………………………………………………………………………………
RECEIVER’S SIGNATURE (PLEASE SEE NOTES OVERLEAF)
BANKS ARE ADVISED NOT TO ACCEPT CHANGED BILL OR PART PAYMENT TOWARDS THIS BILL.
RECEIVERS SIGNATURE (PLEASE SEE NOTE FOR WATER TARIFF & METER RENT)
WARNING : IF ARREARS EXCEED THE SECURITY DEPOSIT THE SUPPLY IS LIABLE TO BE DISCONNECTED. IN ANY CASE IF TWO CONSECUTIVE BILLS ARE NOT PAID, THE SUPPLY WILL BE DISCONNECTED.
DRAFT BILL FORMAT
GOVERNMENT OF GOA
PUBLIC WORKS DEPARTMENT
Division Consumer Code Bill No.
Sub Div. Category Meter No. Date of Fixing
Issue Date Min.
Units:
Avg:
Units:
Form Date To Date Sec. Dep. Rs
Current Reading
Previous Reading
Additional Units
Units Billed
Water Charges
Meter Rent
Sewage Charges
Sundry Charges
Arrears
Gross Amount
Credits
Amount Payable on or
before
Delayed Payment Charges
Amount Payable on or
before
.
Receipt No. Cheque No.
Date Date
(Please see overleaf for notes) NY Receiver’s Signature
Note: Water supply is liable for disconnection if amount is not paid within 30 days from due date. In addition D.P.C. will be charged as per rules.