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Crystal Report Viewer 1

1. This document is an application for a new domestic electricity supply from En Zainal Arifin Bin Musdai for a kampong house located in Bagan Serai, Perak. 2. It includes details of the applicant such as name, ID number, contact details, emergency contact and spouse details. 3. The applicant is requesting a new electricity supply by 25-February-2016 and declares that the information provided is true and agrees to the terms and conditions of the electricity supply. 4. Technical details are provided including the nearest customer account number, electrical pole number, proposed tariff, load details, and contractor information. Space is also included for office approval.

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Cahaya Serai
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29 views

Crystal Report Viewer 1

1. This document is an application for a new domestic electricity supply from En Zainal Arifin Bin Musdai for a kampong house located in Bagan Serai, Perak. 2. It includes details of the applicant such as name, ID number, contact details, emergency contact and spouse details. 3. The applicant is requesting a new electricity supply by 25-February-2016 and declares that the information provided is true and agrees to the terms and conditions of the electricity supply. 4. Technical details are provided including the nearest customer account number, electrical pole number, proposed tariff, load details, and contractor information. Space is also included for office approval.

Uploaded by

Cahaya Serai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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COMMERCIAL / DOMESTIC ELECTRICITY SUPPLY APPLICATION

FOR OFFICE USE


eApplicationID: 0224-A17KR-2016
Station Code:
Business Code:

200866-W

Extension No.:
Account No.:
Contract No.:

SECTION 1: A) APPLICANT'S DETAILS


Name : En Zainal Arifin Bin Musdai
NRIC No.: 671007-08-6159
Non-NRIC ID No. / Passport No. : N/A

Company Registration No. : N/A

B) ADDRESS
Premise Address : NO 144A,
Parit HjTaib 3,Alor Pongsu,,
,
34300 BaganSerai, Perak
Home Phone No. :
Office Phone No. :
Handphone No. : 0195582121
Fax No. :
Email :

Premise Status : Owned


Type of Residence : Residence: Kampong House

Phone No.:

EMERGENCY CONTACT PERSON DETAILS


Name : Puan Siti Sarah Binti Mohd Abdul Mujed
Nationality : Malaysian
Email :
C) TYPE OF APPLICATION:

IC No. : 890506086014
Telephone No. : / /
Relationship : Spouse

New Electricity Supply


25-February-2016

D) SUPPLY REQUEST DATE:


E) APPLICANT'S DECLARATION

Whereby:
1. I hereby attest that the contractor appointed by me/houseing developer as named herein is a contractor registered with Energy Commission. I also give permission to
the contractor to do all necessary works related to my application.
2. I hereby agree to be bound by all terms and conditions relating to electricity supply of TNB as in Syarat-syarat Bekalan Bagi Pengguna Domestik.
3. I hereby agree to pay/settle all connection charge (if any) and deposits prior to the electricity supply.
4. I hereby agree to assist TNB to obtain the landlord's permission to connect the supply to the said premise.
5. I have no objections for TNB to utilise the five-foot mains in my premise.
6. I hereby acknowledge that all information given are true and TNB shall have the right to take any action if the information given are false.

Signature

RM10.00
Stamp Duty

Date

Applicant's Name

PART 2: ELECTRICITY SUPPLY


0023608204

Nearest Customer Acc. No.

PHT 13/1B

Nearest Electrical Pole No.


Proposed Tariff
Meter Type
Load Detail

1 Phase 240V
Total Load
Connected (kW)

Maximum
Demand (kW)

Existing Load

0.00

0.00

New Load

2.00

1.50

Total Load

2.00

Contractor Information
Company Name : AMSO ENTERPRISE
Company No. : IP0098398K
Address : 21, TMN SERAI WANGI
KERIAN
34300 BAGAN SERAI, Perak
No. Telefon : 0195104041

Company
Stamp

1.50

PART 3: FOR OFFICE USE


Existing
Tariff

Meter
Size

New
Existing
New

Connection
Charge (RM)

APPROVED BY:
Signature :

LKKK/BKKM No.

Officer Name :

Project No.

Staff No. :

Deposit (RM)

Date :
Supply Date :

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