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This document is an application for a new domestic electricity supply. It provides details about the applicant such as name, address, and contact information. It also includes information about the proposed electricity supply such as the nearest customer account number, electrical pole number, proposed tariff type, meter type, estimated load, and contractor details. Upon approval, it will record the connection charge, LKKK/BKKK number, project number, and deposit amount. The applicant declares that the information provided is true and agrees to the terms and conditions of the electricity supply.

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CK Aina
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
69 views

Print Formv 2

This document is an application for a new domestic electricity supply. It provides details about the applicant such as name, address, and contact information. It also includes information about the proposed electricity supply such as the nearest customer account number, electrical pole number, proposed tariff type, meter type, estimated load, and contractor details. Upon approval, it will record the connection charge, LKKK/BKKK number, project number, and deposit amount. The applicant declares that the information provided is true and agrees to the terms and conditions of the electricity supply.

Uploaded by

CK Aina
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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COMMERCIAL / DOMESTIC ELECTRICITY SUPPLY APPLICATION

FOR OFFICE USE


eApplicationID: 0230-C17YS-2011 Ext No.
Station Code Account No
200866-W Business Code Contract No

SECTION 1 : A) APPLICANT'S DETAILS


Name :Pengurus BERTAM PROPERTIES SDN BHD Company No. : 227909-V
New IC No.: -- Old IC or Passport No: N/A
B) ADDRESS
Premise Address : PLOT FASA 12A
Premise Status : Owned
LOT-LOT 12004-12141, JALAN BERTAM PERDANA
Type of Residence : Residence: Link House (1 storey)
BERTAM PERDANA 3
13200 KEPALA BATAS Pulau Pinang
Mailing Address : NO 1
BERTAM PROPERTIES SDN BHD ,
Telephone (H) : 045782020
JALAN DAGANGAN 1, PUSAT BANDAR BERTAM
Telephone (P) :
PERDANA
Mobile Phone :
BERTAM , 13200 KEPALA BATAS
Fax : 045759364
Telephone : 045782020
E-mail :
EMERGENCY CONTACT PERSON DETAILS
Name : En AHMAD NOR BIN SABU IC No.: 670223025081
Nationality : Malaysian Telephone : 045782020 / /
E-mail : Relationship: Others
C) TYPE OF APPLICATION: New Electricity Supply
D) SUPPLY DATE:

E) APPLICANT 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.

RM10.00
Signature Date Stamp Duty

Applicant's Name

SECTION 2 : ELECTRICITY SUPPLY DETAILS

Nearest Customer Acc No: Contractor's Details


Company Name : SINAR PENAGA ENTERPRISE
Nearest Electrical Pole No:
Company No.: PG0191573-X
Proposed Tariff : Address : NO 3, JALAN PENAGA
KUALA MUDA
Type of Supply /
13110 PENAGA , Pulau Pinang
Meter Type : 1 Phase 240V
Telephone : 0174219094
Load Detail
Company
Estimated Connected
5.00 Stamp
Load (kW)

SECTION 3: FOR OFFICE USE


APPROVED BY :
Connection
Existing
Charge (RM)
Tariff
New Signature :
LKKK/BKKM No.
Existing Officer Name :
Meter Project No.
Size New Staff No. :
Deposit (RM) Date :

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