|For Oftice Use TENAGA APPLICATION FOR |Application No: NC-000-098-1667 Aa ELECTRICITY SUPPLY Serce Request No: Salutation : Given Title i Name of Applicant: SHUHAIZASALMIBINTI HASSAN MyKad/ Passport: 830312-07-5582 Mother's Name : LETIPAH BINT| OTHMAN Date of Birth 1 12-Mar-1983 Home/Office No : Fax No : Mobile No : 0124748469 Email Address : shuhaiza83@yahoo.com GST Number a Next of Kin : WAN RAHIZULBIN WSALLEH — Next of Kin Phone No: 0124778469 a. Address of Premise : 32A,LORONG MEKAR SARI 5,TAMAN MEKAR SARI,13200 KEPALA BATAS,PULAU PINANG b. Status of Supply + SUPPLY APPLICATION - GROUP MOVE IN ¢. Premise Type 1 RESIDENCE: BUNGALOW (1 STOREY) d. Correspondence Address + 32A,LORONG MEKAR SARI 5,TAMAN MEKAR SARI,13200 KEPALA BATAS,PULAU PINANG e. Supply Required Date : 23-Jul-2018 Poteuaeiaseir) Crain, 1. 1/ We hereby attest thatthe contractor appoted by me / us the housing developer a stated hereln is a contractor registered with Energy Commision.1/ We ‘ako hve permission to the contractor to do all necessary works related to my / ou aplication. 2. 1/ We hereby attest tht the wring ls completed In all aspect and al electical safety fextures have been completed as per standards prescribed by Energy Commieson. 3. 1/ We hereby agree to be bound by al terms and conditions relating to electric soppy of TNE 26 attached "Terms and Conditions”). 4 Tenanted of Occupied Premises |. understand and agree that 2s the registeres consumer for elecucy athe sald premise 1 wl be [Kable for any elec consumed durag the tenancy and/or occupancy period including but not hited to any loss or damage suffered by Tas ‘permitted under the ESA. 1A Lagree to ensure the meter, TWB's Installation and or equpment a the sald premises is not tempered at anytime during the tenancy o occupancy period. I hereby agre to asist TNS to obtain the landlord's parmlsion to connect the electrcy supply tothe sald pemizes. |x Lagroe thatthe fallare to obtain the consent ofthe landlord may delay the electricity supply connection tothe sald premises. 5. 1/ We hereby acknowledge that al nformation given ae rue and accurate and TNB shall have the right to take any action Induding but not ited 82 ‘disconnection of supply andor termination of corract the information given are false and inaccurate. {6 _1//We agree that the Terms and Condtions as attached herein shall become part anda blading contract upon exseutin of this Contract by both partes and/or ‘upon neticaton of scepeance by THB config thatthe application for electricity supply ssacestol sent to me/us. 7. 1/ We asthe signatory below do hereby consent to TMB, Is agents and / ors permitted asigs for collecting, recording, holding o staring my / or personal ‘data or caring out ny operation or sat of operations on my / our personal data within the meaning ofthe Personal Data Protection Act 2010 ane Osta Protection & Priecy Poy lauding but not imied 9 any information, documents, records and accounts necesrary forthe performance ofthis contract. Sirupaiaa Qavat pints Assan ‘Applicant's 7 Name, Designation & MyKad Number of Company Stamp (whichever applicable) ‘Applicant signing for the Company 18/7/2018 83031 ~07- 5582.