Please Attach:

Copy of ID / Certificate of Registration

Copy of KRA PIN
Ownership document or Tenancy
Agreement
SUPPLY CONTRACT

Reference Number: Account No:

THIS FORM IS NOT FOR SALE

1. CUSTOMER DATA

Surname/Company Name: First Name: Middle Name:

ID/Passport/Certificate of PIN Number: P.O. Box: Town of residence:

Registration No.:
Postal Code:

County of residence: Sub-County: Constituency: Village:

Street/Estate: Mobile No:

Email address:

Contact Person: Contact Person’s Mobile No:

Name of Employer: Occupation: Staff No:

Bill Payer Data (only if different from customer)

Surname/Company Name: First Name: Middle Name:

Identification Type: Identification No: Country: P.O. Box: Postal Code:

Town:

Mobile No: office Tel: Email address:

2. SUPPLY LOCATION DATA

County: Sub-County: Constituency:

Village: Street/Estate: Plot/LR No:

Voltage: Connection Type: Method of Charge No:

Single Phase: Domestic: Domestic:

Three Phase: Business: Business:

Authorised Maximum Demand (AMD):

3. DEPOSIT

Amount: Receipt No:

“For Official Use Only” (*) See reference at the back

4. SUPPLY AGREEMENT

I/We the undersigned owner/tenant/occupier of the premises stated under the title of supply data
agree with the company to take a supply of Electrical Energy at the mentioned premises, to all the
lighting points, apparatus and motors installed not exceeding the kVA stated in the item and (kVA)
and in respect of any variation. I/We agree to notify the company under the Schedule of Tariffs 2018
as amended from time to time or in any bylaws therefore and as specified below and I/We hereby
agree as per Energy Act 2019:

a) To pay the charges for such supply from time to time as published by EPRA or in any Bylaws
substituted therefore, and the prices are published in the Kenya Gazette.

b) That provisions of the conditions contained in the Supply Contract and Conditions as amended
from time to time shall be the basis of and from part of my/our contract with the Company.

c) To allow authorized Kenya Power personnel entry into the premises of supply for purpose of
reading the meter and inspecting the installation to ascertain that the same is in good working order.

d) To avoid any kind of meter damage and/or meter tampering to avoid unauthorized/fraudulent use
of electricity.

The maximum demand of this supply will not exceed the kVA stated in the item AMD (kVA) without
the written consent of the company.

The method of charge are specified in Schedule of tariffs 2018 as amended from time to time by EPRA
or in any Bylaws substituted therefore, and the prices are published in the Kenya Gazette.

For and on behalf of the customer

Signature ………………………..........…………....……. Date…………………………………….........………

We undertake to supply above the subject to the provision of Energy Act 2019 and Bylaws from time
to time to enforce thereunder.

For and on behalf of the Kenya Power

Signature ………………………..........…………....……. Date…………………………………….........………

REFERENCES:

1. Contract Expiry Date - For those contracts defined as Permanent, the expiry date is the date when the contract
is cancelled. It is not applicable to any other type of contract.

2. P.I.N – Person Identification Number

3. EPRA – Energy and Petroleum Regulatory Authority

4. Vertical Code – Is the Combination of Floor number and Door number.

5. Voltage – Is the expected voltage calculated by Kenya Power according to the equity for Supply of Electricity
and Inspections carried out at the property

6. Connection Type – Is the connection type to be used by supplying electricity. This is determined by Kenya
Power according to the Equity of Supply of Electricity and Studies carried out by the Kenya Power technical
staff.

7. AMD – Authorised Maximum Demand