Application for Electricity Supply and Agreement Form

Part 1: Customer Personal Data

Applicant's Surname (Mr/Mrs/Miss)

Other Names in Full

Address at which supply is required

House No.

Bus-Stop

Landmark

LGA

Type of Premises

12BR Flat Tenement House 3BR Flat Single Room Shop/Boys Qtrs Block of Flats Duplex Other

Use of the Premises

Residential Commercial Special Industrial

Previous Residential Address

Account Number

Meter Number

Name and Address of Employer / Business

Contact Tel. No. (if any)

E-mail

Valid Means of Identification

Personal Identification No. (International Passport, Driver's License, PVC)

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