CR1 Customer Registration Form

TO TATOU VAI

CUSTOMER REGISTRATION — Form CR1

Phone: +682 24479 | www.totatouvai.co.ck

1A — Owner / Applicant Details

Full Name *

Are you owner or tenant? *

Company (optional)

Email *

Landline

Mobile

Applicant ID Type

Upload ID Document

1B — Property Details

Service Address

Property Ref

Village, Tapere, Landmarks

Connected to water network?

Connection Type *

Domestic — [Residential, Churches, Meeting House, Schools]

Commercial — [Businesses, Government, Rental Properties, Hotels, Shops etc]

1C — Preferred Billing Method

Billing Method

1D — Declaration

I declare that the information in this application is accurate. I am authorized to apply on behalf of the legal property owner, or I have obtained the necessary authority from the owner if I am not the owner. I acknowledge that To Tatou Vai's customer agreement applies upon connection or registration, with terms available on their website or in printed form upon request. I understand that providing false information may result in rejection or termination of services.

Declaration Date

Signature *