2000 Homes Rooftop Registration Authorization

Personal Information on Applicant Full Name: MyKad No./Passport No : Address: Postcode: Country: Service Provider Name of Service Provider MyKad/Passport No. Company Registration No.: Company Name: Telephone No: Declaration 1. I hereby declare that all information and accompanying documents submitted herein are true, accurate and complete and shall be part of my application for a feed-in approval. I understand and acknowledge that the omission of any relevant information or document, or the submission of any information or document that is false or misleading may result in the rejection of this application, the revocation of any feed-in approval granted pursuant to this application and/or shall constitute an offence committed by me under the Renewable Energy Act 2011 and/or its applicable subsidiary legislation. I hereby authorize the Service Provider named above to submit this Feed-in Approval application on my behalf but I shall be fully responsible for the contents thereof. I have read and understood all the rules and regulations as stipulated in the Renewable Energy Act 2011, its subsidiary legislations and SEDAs Guidelines and Determinations. This Registration complies with the provisions of the Renewable Energy Act 2011 and subsidiary legislations made thereunder. Name: MyKad No./ Passport No: Date:
Form version: 1.0/11-12-2012

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2. 3.

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Service Providers Declaration I, [Name: .., MyKad No.: ], the service provider, hereby agree that all the clauses in the above declaration by the Applicant shall apply to me in making this application on behalf of the Applicant. Service Provider Name: MyKad No. / Passport No: Date: *The service provider can be a main engineering procurement and construction contractor, system integrator or
technology provider based in Malaysia. The Applicant may also be its own service provider provided that its employees possess the applicable qualifications. A service provider may also be one of the qualified persons.

Form version: 1.0/11-12-2012

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