New Customer Application

Utilinova - New customer application form v2

Service requested

Pre-paid Electricity, Water and Sanitation

Post-paid Electricity, Water and Sanitation

Pre-paid Electricity Only

Post-paid Electricity Only

The customer hereby acknowledges the contents of and accepts the Utilinova Terms and Conditions recorded in this agreement.

Main Applicant details:

Name & Surname

First name

Surname

Identity / Passport No.

Telephone (Work)

Mobile number

Email address

Co-Applicant details (if applicable):

Name & Surname

First name

Surname

Identity / Passport No.

Telephone (Work)

Mobile number

Email address

Property to be supplied with utilities:

Complex/Estate name

Unit number

Move-in date

Supporting documents: Main Applicant

RSA ID Document or Passport or CM29/COR39 & CM22/COR21 or Ck1 or Trust Deed & Letters of Authority

Maximum file size: 10MB

Allowed file types: .jpg, .jpeg, .jpe, .doc, .docx, .pdf

Attach a copy of the Lease Agreement

Maximum file size: 33.55MB

Allowed file types: .jpg, .jpeg, .jpe, .doc, .docx, .pdf

Supporting documents: Co-Applicant

RSA ID Document or Passport or CM29/COR39 & CM22/COR21 or Ck1 or Trust Deed & Letters of Authority

Maximum file size: 10MB

Allowed file types: .jpg, .jpeg, .jpe, .doc, .docx, .pdf

Declaration and Consent:

I / we declare that the information we have given in this application form is true and correct to the best of my/our knowledge and that I/we have not failed to provide any information which, if the Landlord had known such information, would have not allowed the application to be successful.

The Applicant(s) consents to and authorises Utilinova, or its nominee to:

Contact, request and obtain any information at any time and from any credit provider (or potential credit provider) or registered credit bureau in order to assess the behaviour, profile, payment patterns, indebtedness, whereabouts, and creditworthiness of the Applicant; and

Provide any information about the behaviour, profile, payment patterns, indebtedness, whereabouts, and creditworthiness of the Applicant to any registered credit bureau or to any credit provider (or potential credit provider) seeking a trade reference regarding the Applicant’s dealings with Utilinova, or its nominee.

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New Customer Application

Main Applicant details:

Co-Applicant details (if applicable):

Property to be supplied with utilities:

Supporting documents: Main Applicant

Supporting documents: Co-Applicant

Declaration and Consent:

Address

Customer Support