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Application for Electricity Supply & Agreement Form
Customer details
Bio Data
Applicant Photo *
Surname *
Other Names *
Address
Landmark *
State
Abia
Anambra
Ebonyi
Enugu
Imo
LGA
Aba North
Aba South
Arochukwu
Bende
Ikwuano
Isiala Ngwa North
Isiala Ngwa South
Isuikwuato
Obi Ngwa
Ohafia
Osisioma Ngwa
Ugwunagbo
Ukwa East
Ukwa West
Umuahia North
Umuahia South
Umu Nneochi
Aguata
Anambra East
Anambra West
Anaocha
Anyamelum
Awka North
Awka South
Demili North
Dunukofia
Ekwusigo
Idemili South
Ihiala
Njikoka
Nnewi North
Nnewi South
Ogbaru
Onitsha North
Onitsha South
Orumba North
Orumba South
Oyi
Abakaliki
Afikpo North
Afikpo South
Ebonyi
Ezza North
Ezza South
Ikwo
Ishielu
Ivo-Ebonyi
Izzi
Ohaozara
Ohaukwu
Onicha
Aninri
Awgu
Enugu East
Enugu North
Enugu South
Ezeagu
Igbo Etiti
Igbo Eze North
Igbo Eze South
Isi Uzo
Nkanu East
Nkanu West
Nsukka
Oji River
Udenu
Udi
Uzo-Uwani
Aboh-Mbaise
Ahiazu-Mbaise
Ehime-Mbano
Ezinihitte-Mbaise
Ideato North
Ideato South
Ihitte-Uboma
Ikeduru
Isiala-Mbano
Isu
Mbaitolu
Ngor-Okpala
Njaba
Nkwerre
Nwangele
Obowo
Oguta
Ohaji-Egbema
Okigwe
Onuimo
Orlu
Orsu
Oru East
Oru West
Owerri Municipal
Owerri North
Owerri West
Type oF Premises *
Duplex
3 Bedroom Flat
2 Bedroom Flat
Single Room
Block of Flats
Tenement House
Boys Quarters
Shop
Individual
Other (please specify):
Other Premises Type:
Use of Premises
Residential
Commercial
Industrial
Street Light
Email
Contact Tel No.
Mobile No.
Customer Previous Details
Customer Address
Account No.
Meter No.
District
Aba
Abakpa
Abakaliki
Ariaria
Awka
Awkunanaw
Ekwulobia
Mbaise
New Owerri
Nnewi
Nsukka
Ogbaru
Ogidi
Ogui
Onitsha
Orlu
Owerri
Umuahia
Name of Employer
Address of Employer
Landmark
Pin Code
Means of Identification
Intl Passport
Drivers Licence
PVC
Personal Identification No.
I AGREE TO GET DIRECT CONNECTION IF METER IS NOT AVAILABLE, PENDING ITS AVAILABILITY.
Select Accept if Agreed
i Accept
i Dont
Landlord details
Landlord Surname
Landlord Other Names
Phone
Email Address
NAME OF EMPLOYER/BUSINESS
Address of Employer
Meter Account No.
Customer Account
Customer Preferred Method Of Payment.
Cash
Cheque
Online
POS
ATM
Preferred method of Receiving Bills
Bill Sent By Email
Bill Sent By SMS
Bill Delivery to the House
Personal Identification Type
Intl Passport
Drivers Licence
PVC
Personal Identification No.
I confirm that the Applicant is my tenant and certify his/her request for electricity supply and also accept to notify GEOMETRIC in writing when he/she gives notice (in writing or otherwise) of termination of his/her tenancy agreement, failing which any outstanding debt or dues on his/her account may be debited to my own account.
Disclaimer
“It is not the responsibility of GEOMETRIC to carry out load separation for the purpose of metering block of flats. Kindly contact a certified electrician to ensure that the load wires are properly separated. Do not use GEOMETRIC staff for this purpose”.
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