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NEW CONNECTION FORM

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A: APPLICANT DETAILS
First Name: Last Name:
Occupation:

B: CUSTOMER CATEGORY (tick applicable box)*
1. Domestic                 2. Commercial 3. Industrial         4. Government Institutions
5. Others Institutions  6. Kiosk           7. Tanker/Dumper 8. Others                          

C: SERVICE REQUIRED (tick applicable box)*
1. Water             2.Sewerage Only 3. Water & Sewerage 4. Others      

D: ADDRESS OF PHYSICAL LOCATION FOR CONNECTION
District: Ward:
Street/Road: Houseno:
Plot.:

E: APPLICANT CONTACTS
Email: Phone No:
Statement by Person/Entity Responsible for paying Deposit, Connection Charges, Monthly Bills and other Related Charges: Applicant/Landlord (delete inapplicable)*
  1. I,the undersigned, hereby acknowledge:                                     .
  2. Where the Applicant is not the Landlord of the connection address, Dawasco requires prior written approval from the Landlord that the Landlord is responsible for payment of all relevant charges. If an Applicant vacates the connection address with unpaid charges, the Landlord shall be held legally responsible for setting all such unpaid charges, including any related penalties or legal costs arising.
  3. That no connection work by any party will begin until the survey is approved by Dawasco
  4. That I require to sign a formal Customer Contract ("Contract") and pay the required security deposit, as well as any connection or other charges before any work begins on a new connection, or the connection is activated ortranferred in the case of an existing registered connection.
  5. I will be required to submit two (2) ID photographs when signing the Contract

F: ATTACHMENTS NEEDED
Tick the below scanned copy if available
Afisa Mtendaji    

G: UPLOAD
You should upload the the Complete document should be in pdf format contains Scanned Afisa mtendaji letter.
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