AUTHORIZATION

Re: Service Application No. _____________________________

Date: ___________________________

Manila Electric Company

(Name of) Business Center
(Address)

Gentlemen:

I hereby authorize _______________________________________________ to act as my representative

in connection with my application for electric service/s at ______________________________________
(the "Application") and, for such purpose:

1. to execute or sign any and all of the following documents on my behalf:

# Requirement/s
1
2
3
4
5

2. to transact with your Company, submit any and all required papers or documents and pay all
necessary fees and deposits in connection with and to facilitate the processing of my Application; AND

3. to do any and all acts necessary for the processing of my Application.

By executing this Authorization, I hereby affirm and agree to be bound by the representations,
warranties and actions of my representative and to comply with the terms and conditions for the
provision of electric service at the address aforementioned.

In case there are changes in the foregoing authorization, I undertake to immediately notify Meralco of
any and all such change/s; and I will defend, protect, indemnify and hold Meralco and its officers,
directors, representatives and agents free and harmless from, and against any and all, delays, tosses,
liabilities, demands and claims of whatever nature and kind, arising out of my failure to make such
notification.

For your reference, attached are photocopies of my ID and that of my representative.

Rex Jhefferson Cafe Daz

Applicant Signature Over Printed Name

______________________________________________
Authorized Representative Signature Over Printed Name
 CUSTOMER'S SERVICE APPLICATION WARRANTY

Pangalan ng Customer : Rex Jhefferson Cafe Daz

Pangalan ng Authorized Representative, kung mayroon : __________________________________________
Lokasyon ng Serbisyo (Service Address) : __________________________________________
Bock 8 Lot 26 Pagsibol Village
Serbisyo ng Kuryente/Aplikasyon Bilang (Service ID No./Application No.) : __________________________________

Sa pamamagitan at bisa ngkasulatang ito,aking ginagarantiya at sinlsiguro na ako ay may karapatang tumira
at gamitin ang bahay/gusali na pagkakabitan ng kuryente at ako ay may karapatang gumamit ng nasabing kuryente.
Pahihintulutan ko ang MERALCO na pumasok sa nasabing bahay/gusali upang itayo / ilagay/ kabit ang anumang
pasilidad para sa serbisyo ng kuryenteng aking kailangan;

Aking sisiguruhin na hindi madadamay, at aking ipagtatanggol at pinapalaya, ang MERALCO, ang mga
direktor,·opisyal, empleyado, ahente o mga representate nit'o sa anumang ·kaso, habla, demanda .o reklamo na
maaaring isampa ng ibang tao dahil sa aking pag-mamay-ari o pag-gamit ng nasabing ari-arian, kasama na rito ang
pagpapakabit ko at pagpapakinabang ng serbisyo ng kuryente;

Hindi ako tututol sa pagkakataon na kailangan ang pagputol ng aking serbisyo ng kuryente, pag-alis ng mga
linya, metro at iba pang pasilidad ng kuryente o pagwakas ng kasunduan ng serbisyo ng kuryente sa ilalim ng nabanggit
na SIN/Application, matapos akong bigyan ng kaukulang paunawa ng Manila Electric Company o ng mga kinatawan
nito, sa aking paglabag sa Customer's Service Application warranty na ito o sa pangyayari ng anuman sa mga
sumusunod:

1. Kung ang may-ari ng lupa/gusali/daanan, kung saan ang serbisyo ngkuryente ay ipinagkaloob, ay
humiling na ipatanggal ang serbisyo ng kuryente o wakasan ang kasunduan sa serbisyo ng kuryente;

2. Kung ang pagputol o pagtanggal ng serbisyo ng kuryente ay alinsunod sa batas o alituntunin, o ayon sa
utos ng hukuman o sangay ngpamahalaan;

3. Kung may sakuna o kailangan unahin ang kaligtasan ng mga tao;

4. Kung may nakakabit na linya ng kuryente mula sa aking bahay upang bigyan ng serbisyo ang_ibang
bahay ("flying connection");

5. Kung ang aking metro ng kuryente ay inilipat nang walang pahintulot o di kaya ang Hnya ng kuryente ay
inilipat papunta sa isang serbisyo;

6. Kung ang anumang papeles, dokumento o kaalaman na aking ibinigay sa Meralco kaugnay sa aking
aplikasyon sa serbisyo ng kuryente ay natagpuang mapanlinlang, huwad o daya;

7. Kung ako ay lumabag sa anumang mga gawa na ipinagbabawal ayon sa nasasaad sa Section 4{a) ng
R.A. 7832 o mas kilala sa "Anti-Pilferage Act of 1994" at ng Implementing Rules and Regulations nito;

8. Kung ako ay nagkulang sa pagbigay sa Meralco ng mga kailangang papeles o dokumento sa loob ng
isang daan at dalawampung {120) araw mula sa araw na nabigyan ako ng serbisyo ng kuryente o kapag
hiningi ang mga ito ng Meralco; o di kaya

9. Kung ako ay lumabag sa kasunduan sa pagbibigay ng serbisyo ng kuryente ng Meralco.

Kusang loob kong nilagdaan ngayong_____araw ng buwang______, taong_______ sa _______.

Rex Jhefferson Cafe Daz

LAGDA SA IBABAW NG PANGALAN

Nilagdaan sa harap nina

___________________________________ ___________________________________

------------------------------------------------
1 Ang Pagpapaubaya na Ito·ay hindi maaaring maging hadlang sa Meralco upang slngilfn ang anumang pagkakautang ng Applicant/Customer.
Anumang pagkaantala o kaluwagan ng Meralco a pagpapatupad, maging sa kabuuan o bahagi lang, ng kahit anong karapatan, lunas, o
pananagutan ng Applicant/Customer na ibinigay dlto at may kaugnayan sa Contract For Electric Service ay hindi maaaring batayan upang
ipagpaubaya ang kahit anong karapatan, lunas o ,pananagutan na nabanggit.
 DATA PRIVACY CONSENT STATEMENT

I hereby give consent to, and authorize Manila Electric Company (MERALCO), its directors, officers, employees, authorized
representatives or third parties, to collect, record, store, use, disclose, share, update, modify, block or erase, monitor, or otherwise
process (collectively, "Process/Processing") my Personal Data, in accordance with R.A. No. 10173 "The Data Privacy Act of 2012"
and its implementing rules and regulations and any of its amendments. These Personal Data refer to all personal, sensitive or
confidential information provided or to be provided to Manila Electric Company (MERALCO), its directors, officers, employees,
authorized representatives including but not limited to
the following:

1. Information given when applying for service, such as my name, address, phone number, email address, Tax Identification
Number (TIN}, evidence of authority to occupy, and, if applicable, details of my authorized representative;
2. Billing and payment information used to pay my electric consumption. However, details of the payment instrument (like prepaid
card-debit card, credit card) used to pay my bills via Meralco Online are captured and processed by the payment gateway
service provider;
3. Information to determine eligibility to participate in certain energy programs or services;
4. Information I filled out in any form on our website or online facilities, such as, when I wish to contact Meralco to lodge my
concerns, to register at Meralco Online, to avail of its on-line application, outage notifications, and billing and/or payment
services;
5. Information given when I communicate with MERALCO and/or any of its representatives (e.g., Call Center
Representatives, etc.}:
6. Responses provided when I or my representative participate in our customer surveys;
7. Information provided for verification purposes (e.g., to facilitate refunds or to avail of zero-rated VAT transactions;
8. Any other information voluntarily provided for any legitimate purpose declared at point of collection of such
information.

I agree that these data shall be used and/or processed for any legitimate purpose, including but not limited to the following:

a. Notification on the service application, bill payments, outages, marketing or promotional information, updates, alerts, or other
concerns;
b. Supply or continuous improvement of the electric service as well as management of the service account such as payment
options and · eligibility for refunds; ·
c. Response to service inquiry, concern or complaint;
d. Verification of identity whenever accessing the account through the various customer engagement channels {e.g., e-mail,
website, mobile application, via phone call, walk-in);
e. Conduct of research involving the business of MERALCO or electric distribution services, in general;
f. Protection of my interest and/or that of other MERALCO customers; or
g. Compliance by MERALCO with its obligations under its contract, applicable laws and regulations or pursuant to lawful orders
of competent authorities or for public order and safety or in cases of emergencies

I acknowledge that I am afforded certain rights such as the right to verify, correct or modify, or remove these personal data or
withdraw my consent and/or edit my consent preferences at any time through a written request to MERALCO's authorized
representatives. I hereby agree that said personal data shall not be shared by MERALCO to third parties except to those provided
above, or in special circumstances where I have given my specific consent or as allowed by pertinent laws, rules, or regulations. l
acknowledge that said third parties have been required to abide by the Non-Disclosure Agreement, if applicable, and implement
their own data privacy program to secure and keep the subject information confidential in accordance with law.

I hereby warrant that I have read and carefully understood MERALCO's Privacy Policy, stated in http://www.meralco.eom.ph/privacy-
policy. and that I knowingly and voluntarily executed this consent statement in accordance therewith. l confirm that I have obtained
prior consent from the registered customer or applicant residential owner or user, company or business I represent and its officers
before disclosing their information to MERALCO and ln providing this consent in their behalf.

I hereby allow MERALCO, its directors, officers, employees, authorized representatives or third parties to process these personal
data from their submission and for the duration of my electric service contract with MERALCO until there are unpaid bills, charges,
deposits or refunds on the service account and in case the application does not proceed, the data shall be stored and/or processed
only within twelve (12) months from submission or last updating of the data, subject to the retention limits set by applicable laws
and regulations. Thereafter, the personal data shall be disposed or discarded in a secure manner that would prevent further
processing, unauthorized access, or disclosure to any other party or the public.

Rex Jhefferson Cafe Daz

Name of Customer/Representative Company/Business Entity

Position Date