Application For Water Service Connection/ Individual Or Domestic Connection

Potable Wastewater

Tenant Owned

New Connection Existing Connection

Customer Number (If existing please indicate customer no. if applicable):

PC/Plot number:

Marital Status :

CONSUMER DETAILS

First Name:

Middle Name:

Last Name:

Identity Document Type

Identity Number/Passport Number:

Date of Birth:

Postal Address:

Tel (Home):

Tel (Work):

Email Address:

Cell:

Current Physical Address

Plot No.:

Area/ward:

City/Town/Village:

SERVICE CONNECTION DETAILS

Ward/Area:

Plot No.:

Village/Town/City:

OWNER/LANDLORD CONTACT DETAILS

Owner's Name

Plot No.:

Area/ward:

City/Town/Village:

Tel (Home):

Cell:

Fax:

E-mail:

Owner Identity Document Type

Owner Identity Number/Passport Number:

Attach Applicants Identity Document :

Attached Title Deed :

Attach Lease Agreement :

Attach Owner's / Landlord's Identity Document :

* Note : The uploaded documents should be certified by relevant authorities.

I, declare that I have consulted the owner/landlord about this connection and has given me permission to proceed. I also declare that to the best of my knowledge and belief the information in this application and the accompanying documents is true and correct and have read and understood the Waterworks Act and all the relevant Legislation and Regulations

I, declare that to the best of my knowledge and belief the information in this application and the accompanying documents is true and correct and have read and understood the implications of the Waterworks Act and all the relevant Legislation and Regulations

I accept WUC Terms & Conditions

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