Form ACOt Ver. 109 ELECTRICITY SUPPLY APPLICATION “TYPE OF APPLICATION New Electrity Supply [1 New etectricty Supply Pre-Payment) Syarikat SESCO Berhad sr.) [—] Upgrading/Downgraing of Supply Ay omed nine SemckEowgyBated | [] Rewitng/Retestng of Installation PV Generator interconnection” Change to Pre-Payment System Separate Meter Rural Elecrifcation Scheme (RES) 0000 SECTION A: TO BE COMPLETED BY APPLICANT (FORM TO BE COMPLETED IN CAPITAL LETTERS) We hereby request for Electricity Supply tothe under mentioned premises forthe purposes as stated below ‘At. APPLICANT'S DETAIL, Salutation: MMs /Miss/Other Salutation! Applicant's Name ESTEE Si] Ue VS es] Company Narre CompenyBusiness Reisvaton No, si i st i a i i ea ie a iia a es aa es a | {Ed tt El Ea dl a ‘A2. ADDRESS Premises Adress Postcode Pe La | Town {Rt el hE Ke state 8/A|R|Alw) alk Teeprone) LE TLLLLITTLI Toloproneoy LL LL ILI L I Handshone Fax E-mal ! ele Premise Stats Tom Trent Lote, pease specty Type ot Premise ["] Terace House-Sing/Double [] Semi etched House- SingleDouble [Detached House - SiglyDouble [Lvarimenuriacondominiam [] Stophouse[_] Showroom [] Factory []onmers, please specty ‘A3. DOCUMENTS REQUIRED [1] tana Twesale and Purchase Agromen/Tonancy Agreement [1] Pretcopy of denty Card Ey eter tappokiment as auhred satay on behalf company [E]__ Temporary Ocupation conse [L_Panghut Kets Kenpung's mthoreton lotr (or kampung house ori) [] Business Document: Form 49 & Trading Lies 51 consenteter rom co-omners for mile ownerstips of premises [5] Authorisation Ltr fom revant Goverment Dept. ‘Ad, DECLARATION BY APPLICANT |U We shall abide by the regulations of your company by, iter alia, paying the required amount of deposiiconnecton charges to SESCO before any works. shall be eartied out \Uwe undertake that any debit balance in excess of the deposit wll be setied by meius immediately upon receiving the bil faling which the debit balance shall be raised through my electricity account Uwe also undertake to engage suitably qualified and registered contractor(s) as approved by SESCO forthe works tobe carried out ‘Company's Namo & StamprSeal Signature Name of Applicant Date “Note: Sie of PV should not exceed MD applied. This I to ensure thatthe system capaciy is adequate. FOR OFFICE USE covet LLL LLL ILL || romeo oLL LLL LL II | Srctatationno, 7L{ 11 tii coat = ALLL TLL TUTTI se aL LLLP IA] Parner = aL LILI IIIS ‘sn 1 Contract AceSECTION B: TO BE COMPLETED BY REGISTERED ELECTRICAL CONTRACTOR 1. TYPE OF SUPPLY/ METERING SCHEME B2. DETAILS OF PROPOSED INSTALLATION *Please tick) and delete where not applicable (Please use atachment ithe table space is insufcient) Type of installation No. KW, Underground Cable - Single Phaso! Three Phase (BOA! 100A) Lighting ‘Service Line - Single Phase! Three Phase (60A 100A) Power (Motor) - Single Phase (CT Meter-CT Ratio Power (Motor)- Three Phase High Voltage (HV) Meter (Cooking Appliances ulk-Sub Metering (Bulk Meter No: )| [Water Heater (instantaneous) F13A SIS/O (0A) In Ring Cireut Estimated Maximum Demand (kW) 143A SISIO (20A) in Radial Circuit T5ASISIO Proposed Tarif" ‘Ar Conditioner 0A isolator Existing Meter No. “For any appt ad stove 1 SIVA te cule al bs cand user Soman {ar (13101) a cemond otra B3, ATTACHMENT lenciosed herewith = 1 copy of site plan indicating clearly the location of the premises, meter postion, location of proposed substation (if any), location of proposed ‘main switch board room (fny), pole postion & et. 1 copy of schematic diagram “* The Electical Consultant is required to sign on all documents submitted fr building under their design. Letter of approval of building plan from relevant counci Form EIUIST/1.0- Supervision and Completion! Test Certificate 'SESCO'sleter of approval for Electrical Drawing andlor Centralize Metering Cabinet Drawing andlor MSB Drawing (if applicable) ‘One (1) copy of manufacturer's MSB drawing and factory test result One (1) copy of MSB Primary Injection test result ‘Additonal documents required for (One (1) copy of latter of appointment of Electrical Contractor (EIC) by applicant [- 9PPcation of CT or HV meter (One (1) copy of latter of appointment of Electrical Consultant by applicant Undertaking letter for temporary supply Photocopy of paid connection charges bil (i applicable) Photocopy of paid collateral deposit bl (if appicable) Form ACO4A & ACDAB - For application of demand tariff (C2/C3/23) 4, DECLARATION BY REGISTERED ELECTRICAL CONSULTANT/ CONTRACTOR, "hereby certly the above detais in At - 83 are correct ‘Company's Namo & StampiSeal Es |) ‘Signature of Registered Electrical Consultant Contractor Name ____________________ Contractor Registration No. Date Contiicate Expiry Date ‘Note: The company will not connect any installation which does not confirm fo the Rules, Regulations and Practices and their subsequent amendments Lniess by special sanction of the Director of Electcty Supply. C1. ACCEPTED ON BEHALF OF SYARIKAT SESCO BERHAD (672931-A) Regional Manager/Engineerin-charge Date D1. BULK-SUB METERING SCHEME (FOR SUB-METER) Buk meter no. Slave meter no. Date sub-meter linked to buk meter Verified by Putished by Stategy Development & Implementation Diuion, Marketing & Rea Doparmant,Sykt SESCO Borhad Page 2