80%(5)80% found this document useful (5 votes) 9K views2 pagesKPLC Application Form
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’
NOT FOR SALE-
COSA
‘Surname/Company Name: First Na Middle Namo:
ID/Passport No.: Country: PO.Box: Code | Town:
Mobile: Office Tel: E-mail:
= "County: District: Division:
® ‘Sub-Location: Street: Village Estate:
Contact Person: | Sef ~_
g | _Gustomer Contact Person: Name Telephone
EU aa RL
County District: Division:
Kenya Power
© sien’ Street: Pict: [1 no:
: urn: C]
& Villagetestate: are
é Business
2 LandmarkiRoute map/Site Direction
POWER DATA
New ‘Additional Load Account No Meter-Separation —_Re-routing
‘Type of Application
Others: (Please specify)
No. of Meters Required
ie) Seldom La)
‘Customer Application Numi ‘ADMD.
House NoName No. of Moters ‘Account Number Previous ADMD
‘See the back ofthe form fora lst of allowed types for each numbered data item and a box for helping you work out the ADMD
ADMD: After Diversity Maximum Demand APPLIANCES AND MACHINERY
LIGHTING POINTS (Bulbs) No.
PLUG POINTS (Socket outlets ) ‘Amp
FIXED APPLIANCES (Cookers, Heaters, Air conditions idges, Ovens e-t.c)
1
2
3.
a
5.
6
7
8
D._ MOTORS
Purpose for which required No. Rating (HP or KVA) Phases
1
z
3.
4.
5
6
E. OTHER EQUIPMENT a =
Note: Please attach a separate list if the above space is not adequate
‘Copy of national ID or Passport (non-Kenyans) or Certificate of Registration/Incorporation as appropriate.
‘Clear and detailed route sketch leading tothe premises where supply is required.
‘Sealed site plan (preferably in Softcopy) for Large Power Customers such as Industries, Housing Estates e.tc
Applicants Name |. Signature.
FOR OFFICIAL USE ONLY
.. Date,
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