Application Form "Water Tax Payment"
Applicant's Basic Information
Salutation
Please Select
Mr.
Mrs.
Ms.
Janab
Md.
Dr.
Mx
Sk.
Haji
Mst
Name
Gender
Please Select
Male
Female
Other
Aadhaar Card No
E-mail
Mobile No
Address Information
Country
India
State
West Bengal
District
Durgapur
Ward
.14
0
01
02
03
04
05
06
07
1
11
112
12
12.
13
14
15
16
17
18
19
19*
2
20
21
22
23
24
25
26
27
27.
28
29
29.
30
31
32
33
34
35
36
37
38
39
4
40
41
42
43
5
AGJP
AGP
AP
BGP
DGP
GP
J.G.P
JGP
JP
KGP
MGP
NGP
P
PAN
PANCHYT
PGH
PGP
SGP
Address
Premises No
Pin Code
Holding No
Post Office
Police Station
Details of Water Ferule
Tank No.:
Please Select
0
1
10
11
12
13
14
15
16
16122019
17
19
2
20
21
22
23
24
25
254
3
4
5
6
7
8
9
Ferule size:
Please Select
0.5'' DIA
0.5"
0.5" DIA
0.75 " DIA
0.75"
0.75" & 1"
0.75" DIA
0.75",0.5" & 0.5"
1
1"
1" & 0.5" DIA
1" +1/2" dia
1" dia
1" TEE
1.3/4" DIA
1/" DIA
1/2"
1/2" dia
1/2" DIAS
1/2", 1/2", 1/2"
1/2"DIA
10"
1-1/2"
12/" DIA
2"
2" dia
2/3"
25 MM
3 inch Tee
3"
3" DIA
3" TEE
3",6" & 3"
3"Tee
3/4"
3/4" dia
3/4" SIA
4"
4" DIA
4" TEE
4.40
6"
6" DIA
6" tee
8"
8" TEE
DIA-1"
DIA-40MM
Do you have meter?
Please Select
Meter
Non Meter
Ferule use for
Please Select
Domestic
Industrial
Bulk
Commercial
Meter No.
Consumer No.
Govt.
Housing
/ Bangla
Awas
NO
YES