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Part 1: To Be Completed by Applicant

This document is an application for electricity supply to a domestic premises located at PTB 14428, NO 8, JALAN PERMATA 2/3, TAMAN PERMATA PENAWAR, 81930 BANDAR PENAWAR, JOHOR. The applicant is FADILLAH BINTI YAAKUB with MyKad number 841015-12-5938. If approved, electricity supply would start on April 13, 2020. The applicant agrees to be bound by the electricity supply terms and conditions of TNB and consents to TNB collecting and storing their personal data.

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Ferrarina Yab
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83 views

Part 1: To Be Completed by Applicant

This document is an application for electricity supply to a domestic premises located at PTB 14428, NO 8, JALAN PERMATA 2/3, TAMAN PERMATA PENAWAR, 81930 BANDAR PENAWAR, JOHOR. The applicant is FADILLAH BINTI YAAKUB with MyKad number 841015-12-5938. If approved, electricity supply would start on April 13, 2020. The applicant agrees to be bound by the electricity supply terms and conditions of TNB and consents to TNB collecting and storing their personal data.

Uploaded by

Ferrarina Yab
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR For Office Use

Application No : NC-000-160-4632
ELECTRICITY SUPPLY Service Request No :
Service Notification No :
Electricity Account No :
Please note that only submitted application with complete and correct information will be processed.
PART 1 : TO BE COMPLETED BY APPLICANT:
For Application Under Individual Name:
Given Title : MADAM
Name of Applicant : FADILLAH BINTI YAAKUB MyKad/ Passport : 841015-12-5938
Mother's Name : ROSNI BINTI HJ. MATASAN Date of Birth : 15-Oct-1984
Home/Office No : 078226587 Fax No : 078226587
Mobile No : 0128650550 Email Address : [email protected]
Next of Kin : HAMIZI Next of Kin Phone No : 0197880159

DETAILS OF PREMISES:
a. Address of Premises : PTB 14428,NO 8,JALAN PERMATA 2/3,TAMAN PERMATA PENAWAR,81930 BANDAR
PENAWAR,JOHOR
b. Status of Supply : SUPPLY APPLICATION - EXISTING PREMISES
c. Premises Type : DOMESTIC
d. Correspondence : PTB 14428,NO 8,JALAN PERMATA 2/3,TAMAN PERMATA PENAWAR,81930 BANDAR
Address PENAWAR,JOHOR
e. Electricity Start Date : 13-Apr-2020

APPLICANT'S DECLARATION SECTION:


1. I / We hereby attest that the contractor appointed by me / us / the housing developer as stated herein is a contractor registered with Energy Commission. I /
We also give permission to the contractor to do all necessary works related to my / our application.
2. I / We hereby attest that the wiring is completed in all aspects and all electrical safety features have been completed as per standards prescribed by Energy
Commission.
3. I / We hereby agree to be bound by all terms and conditions relating to electricity supply of TNB as attached ("Terms and Conditions").
4. Tenanted or Occupied Premises
i. I understand and agree that as the registered consumer for electricity at the said premises I will be
liable for any electricity consumed during the tenancy and/or occupancy period including but not limited to any loss or damage suffered by TNB as
permitted under the ESA.
ii. I agree to ensure the meter, TNB͛s installation and or equipment at the said premises is not tempered at any time during the tenancy or occupancy period.
iii. I hereby agree to assist TNB to obtain the landlord͛s permission to connect the electricity supply to the said premises.
iv. I agree that the failure to obtain the consent of the landlord may delay the electricity supply connection to the said premises.
5. I / We hereby acknowledge that all information given are true and accurate and TNB shall have the right to take any action including but not limited to
disconnection of supply and/or termination of contract if the information given are false and inaccurate.
6. I / We as the signatory below do hereby consent to TNB, its agents and / or its permitted assigns for collecting, recording, holding or storing my / our personal
data or carrying out any operation or set of operations on my / our personal data within the meaning of the Personal Data Protection Act 2010 and Data
Protection & Privacy Policy including but not limited to any information, documents, records and accounts necessary for the performance of this contract.

Note: This is a draft document. Please check if your details are populated correctly. You may print this document for
future reference.

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