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Application Form - Water Supply Connection
1. a) TYPE OF REQUEST
Type of Request
*
First Time Connection
Additional Connection
Additional Connection for Tenant
Replacement
1. b) DOCUMENTS PROVIDED
Business Registration
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Lease
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Tenancy Agreement
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Transport
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2. NAME & ADDRESS OF PERSON TO BE SUPPLIED
First Name
*
Last Name
*
Email Address
*
Address
*
Directions
Landline
Mobile
Other
# of Buildings/Plots to be Supplied
Row in Lot
Left
Middle
Right
House/Apartment
First
Second
Third
Fourth
Fifth
Floor in House
Ground
First
Second
3. NAME & ADDRESS OF OWNER OF PROPERTY
First Name
*
Last Name
*
Address
*
4. PERSON AUTHORISED ON BEHALF OF THE CUSTOMER
Authorized Person
*
Owner
Tenant
Agent
Other
First Name
*
Last Name
*
Address
*
5. PROPERTY TYPE
Property Type
*
Residential
Non-Residential
6. EXISTING ACCOUNTS FOR PROPERTY (TO BE CLEARED BEFORE INSTALLATION)
Account # 1
Balance
Account # 2
Balance
7. SIZE & NUMBER OF CONNECTIONS REQUESTED
Connection SIze
3/4 Inch
1 Inch
2 Inch
8. CHANGES TO CURRENT ACCOUNT
Changes to Account
Tariff, Name, Address?
Temporary Construction Connection
Temporary Construction Connection
9. DATE WATER CONNECTION NEEDED
Date Needed
Permanent Connection
Permanent Connection
10. Signature Information
Name of Applicant
*
ID/Passport
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TIN Certificate
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