Electricity and Water Connection Application

Basic Information

Property Number:

Account Number:

Deposit/Guarantee:

Date:

Water Consumption Type:

Electricity Business Type:

Power of Attorney Attached:

Yes No

Manner of Payment:

Financial Institution:

Account Number:

Full Name of Firm:

Trading As:

Registration Number:

Landlord:

VAT Registration Number:

Particulars of Auditor/Accountant:

Telephone Number:

Name and Address of Partners/Trustees:

Name and Address of Legal Persons:

Registered Office:

Name and Address of Members or Directors (not more than 3):

Business Address:

Address Where Services Must Be Supplied:

Postal Address:

E-mail Address:

ID Document:

Company Documents:

Copy Lease Contract:

Signature of Applicant:

Date:

Signature of Official:

Date: