C O N T A C T D E T A I L S Office: 086 186 5826 Fax: 086 626 0633 E - M A I L S w w w. v o l t a n o. c o m A S H F O R D C L O S E, G 0 4 A S H F O R D H O U S E M I D S T R E A M E S T A T E H A L F W A Y H O U S E, 1692 A D D R E S S I N F O info@voltano.com P O S T N E T S U I T E 293 P R I V A T E B A G X 1007 L Y T T E L T O N, 0140 APPLICATION FOR THE SUPPLY OF UTILITIES (WATER, ELECTRICITY & GAS) SECTION A GENERAL INFORMATION This Application Form needs to be completed by the Applicant for the supply of Water, Electricity, and Gas. The following documents must accompany this application. Mark with X if the documents is attached and with N/A if not applicable. Copy of ID Document of the Applicant, or copy of Company/CC/Trust Documents if Legal Entity; Copy of ID Document of the Applicant s spouse; A copy of the lease agreement stipulating the date of occupation; Proof of payment of Connection Fee & Deposit; TERRA NOVA UTILITIES IS ADMINISTERED & ASSISTED BY VOLTANO METERING (PTY) LTD: REG.NR: 2005/015581/07 VAT: 4310222932 OFFICE: 086 186 5826 FAX: 086 235 9618 EMAIL: info@voltano.com WEB: www.voltano.com Estate Name: TERRA NOVA: COSMOS RIDGE Stand / Unit No.: Physical Address: SECTION B LOCATION OF SERVICE APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 1
SECTION C CONNECTION FEE & DEPOSITS For the new utility connections, the Connection Fee needs to be paid by the Owner of the Property. All users will have to pay the Deposit amount. CONNECTION FEE TO BE PAID FOR NEW CONNECTIONS (Responsibility of the Owner) DEPOSIT TO BE PAID BY EACH USER (Responsibility of the Occupant) Water Connection: Electricity Connection: Sanitation Connection: Gas Connection: R 1 500.00 DEPOSIT FOR UTILITIES R 1 500.00 TO BE PAID INTO THE DEPOSIT & UTILITIES ACCOUNT The banking details for the different type of payments are confirmed hereunder: BANKING DETAILS UTILITIES DEPOSIT Account Name: TERRA NOVA UTILITIES Account Name: TERRA NOVA UTI;ITIES Bank: FIRST NATIONAL BANK Bank: FIRST NATIONAL BANK Branch: HATFIELD Branch: HATFIELD Branch Code: 252 145 Branch Code: 252 145 Account Number: 624 174 888 07 Account Number: 624 174 888 07 SECTION D PERSONAL DETAIL TO BE COMPLETED BY THE APPLICANT Full Name: ID No. / Company Reg. No.: Vat No.: Mobile No: Fax Number: Home Tel No.: Do you own or rent? Residential Address: Postal Address: Alternative APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 2
EMPLOYMENT DETAIL: Name of Employer: Occupation: Work Tel No.: Work Fax No.: SPOUSE DETAIL TO BE COMPLETED IF MARRIED: Married in or out of Community of Property: Name of Spouse: ID No.: Mobile No.: Name of Employer: Work Tel No.: ENDORSEMENT: Date: Date: Signature Applicant: Signature Spouse: APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 3
SECTION E TO BE COMPLETED BY OWNER FOR LEASED PROPERTY Full Name: ID No. / Company Reg. No.: Vat No.: Residential Address: Postal Address: Name of Employer: Mobile No.: Tel No. (W): Tel No. (H): I/We confirm that Mr/Mrs/Miss has occupied or will occupy the above premises from and that I/we warrant there are no arrears owing to TERRA NOVA UTILITIES for any services, with regard to the property. I/We the undersigned as owners bind my/ourselves as surety and co-principal debtor in solidium in respect of the tenant account. Date: Signature: Signature of spouse if married in Community of Property: APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 4
SECTION F TO BE COMPLETED BY NEXT OF KIN WITH WHOM YOU DO NOT LIVE Full Name: Identity Number: Residential Address: Postal Address: Mobile No.: Tel No. (H): SECTION G STATEMENT APPLICANT I/We hereby apply for the supply of Water, Electricity and Gas to the aforementioned property, subject to the provisions of the Municipal By-Laws as amended from time to time and General Terms and Conditions as determined by TERRA NOVA UTILITIES. Copies of the above may be obtained from the relevant offices on payment of the prescribe fee. I/We hereby choose as my/our domicillium citandi et executandie (address for service of all documents) for the purpose of this agreement at the address where services will be rendered or the following physical address: I/We hereby state that the information supplied in this agreement is correct. I/We hereby accept the conditions set out in the Municipal By-Laws and General Terms and Conditions as determined by the TERRA NOVA UTILITIES governing the control and supply of the utility services required. Date: Name: Signature: SECTION H TO BE COMPLETED BY JURISTIC PERSON INDICATIONS ASSET VALUE OF / AND ANNUAL TURNOVER FOR PURPOSES OF THE NATIONAL CREDIT ACT Asset value of Juristic Person/ Group of Juristic Persons as per latest financial statements: R APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 5
Annual Turnover of Juristic Person / Group of Juristic Persons as per latest financial statements: R 1 The Applicant hereby applies for the supply of electricity, water and gas (herein after collectively referred to as UTILITY SERVICES ) in this agreement from TERRA NOVA UTILITIES ( TNU ) having control over the supply of utility services of the property to which this agreement relates and accepts responsibility for the payment of all the amounts due for such service. 2 The Applicant will deposit a sum of money as set out above to cover payment of any charges that are due or may become due to TNU. The deposit will not be regarded as payment or part-payment for any accounts due for the sale of utility services. On cessation of the supply of utility services, the amount of the deposit, free of interest less any payments due to TNU, shall be refunded to the Applicant. The amount of the deposit is to be determined by TNU from time to time and may be increased if necessary. 3 The Applicant hereby authorises TNU to appropriate the deposit paid in terms of the agreement to any arrears amounts owing by the Applicant to TNU, which remains outstanding for a period of more than 30 (THIRTY) days or any arrears amounts which remains on any of the Applicant s accounts with TNU at the time that the services are terminated or the account being finalised. TNU shall give notice to the Applicant before appropriating the deposit as set above. TNU may request the Applicant to pay a new deposit in the event that the Applicant s deposit has been appropriated as set out herein. TNU may elect the payment method to issue refunds or deposits or any other redeemable refunds that may be due. 4 The Applicant hereby authorises TNU to apply set off where TNU may deem it necessary. This means that a credit balance in any or all the Applicant s accounts may be used to settle any arrears amounts registered against any or all of the Applicant s accounts with TNU. 5 All payments due to TNU and / or VOLTANO will be seen as one account and payment received will be allocated toward the most seasoned account. 6 The office of TNU should be notified of any change of address in order to facilitate refund of the deposit. If a refund of a deposit has not been claimed within 1 (ONE) year after the agreement has been terminated or the Applicant has ceased for any reason to receive a supply in terms of this agreement such deposit shall become forfeited to TNU. 7 Connection fees are not refundable. SECTION I GENERAL TERMS AND CONDITIONS 8 Written notice of discontinuation of services must reach the office of TNU at least 14 (FOURTEEN) working days before the date of intended termination. It is that transfer or notice of transfer of ownership of the property does not amount to notice of termination of services of this agreement. 9 The Applicant hereby undertakes to notify TNU in writing should he/she fail to receive accounts in respect of services hereby applied for, for a period of more than 1 (ONE) month. 10 In the event of TNU instituting proceedings against the Applicant and/or Resident arising out of the breach of any term or condition of this agreement and/or any breach of the Municipal By-Laws, the Applicant and/or resident shall be liable to pay attorney and own client costs, including the costs of any tracing fees, in respect of such proceedings. 11 It is acknowledged that failure to effect payment of amounts due in respect of services rendered in terms of this agreement or the furnishing of incorrect information in this agreement may lead to summary discontinuation of the supply of such utility services without notice to the Applicant/Consumer, although TNU will not be obliged to discontinue such services. 12 Unless otherwise specified all payments received will be appropriated in the following order: Legal Charges, Interest, Rates & Taxes, Levy, Electricity, Gas, Water, Sanitation, Refuse Removal and Assessment Rates. 13 The Owner may be notified if the Applicant s / Consumer's account reflects an outstanding balance. 14 The Owner and the Applicant will be jointly and severally liable for all the amounts owing in terms of Section 49 of the Local Government Ordinance 17 of 1939 including charges for water and sanitary services. 15 Should this contract be signed by a person in a representative capacity, such person warrants his/her authority to represent the Applicant. In the event of the Applicant being found for any reason not to be bound by his contract, the signing person accepts responsibility for the performance of all terms and conditions of this agreement and/or Electricity and Water By-Laws. 16 The Applicant warrants that in the case of change of ownership of the property an Electrical Compliance Certificate has been obtained. 17 The Applicant hereby consents to the jurisdiction of the Magistrates Court in terms of Section 45 of the Magistrate's Court Act (Act No.32 of 1944) as amended, in respect of any action which TNU may institute against him/her arising out of the Agreement: Provided that TNU shall, notwithstanding the above, have right to proceed with any such action in a competent Court of law. APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 6
18 This application shall be deemed to be accepted by TNU and a Consumer Agreement between the parties valid from the date of signature thereof or the date of occupation of the property by the Applicant, whichever is earlier, upon the lapse of 30 (THIRTY) days from the date of the receipt of this application by TNU: Provided the application is not rejected by TNU within that period. 19 TNU: 19.1 will defer payment by the consumer until TNU has provided a periodic statement of account for that utility or other continuous service and; 19.2 will not impose any charge contemplated in Section 103 of the National Credit Act in respect of any amount so deferred, unless the Applicant / Consumer fails to pay the full amount due within 30 (THIRTY) days after the date of which the periodic statement is delivered to the Applicant / Consumer, and the therefore this agreement is not a credit facility within the meaning of Section 8(3) of the National Credit Act, but any overdue amount in terms of this agreement, as contemplated in subparagraph (ii), is incidental credit to which the National Credit Act applies to the extent set out in Section 5 of the National Credit Act. 20 If the Applicant is a juristic person, the applicant agrees that the information supplied by the applicant in Section H of this application for the supply of utility services shall be the Asset Value / Annual Turnover of the juristic person / group of the juristic persons (of which the applicant forms part) for purposes of Section 4(1)(a) (i) of the National Credit Act, and if these amounts equals or exceed the amount determined by the Minister in terms of Section 7(1) of the National Credit Act, the Act will not apply to any incidental credit agreement or otherwise arising as a result of this agreement. Should the applicant wish to change or amend the deemed amount as per Section H of this application, the duty of the juristic applicant to inform TNU of any changes to its Assert Value / Annual Turnover in writing. 21 The rate of interest charged by TNU on arrear assessment rate and service charges outstanding is determined to be the primeleading rate plus 2% (TWO PERCENT) charged from time to time by the South African commercial banking industry to its ordinary debtors. 22 If the Applicant is the state or an organ of the state, the National Credit Act, will not be applicable as contemplated in Section 4(1) (a) (ii) & (iii) of the National Credit Act. 23 If a payment by cheque or similar instrument for services is subsequently dishonoured by any reason the resulting debt owed to TNU by the issuer of the cheque will not constitute and incidental credit agreement for any purpose of the National Credit Act as contemplated in Section 4(5) (a) of the Act. 24 A defaulting consumer will be issued with a written notice by TNU before sending any default information to any credit bureau. 25 The applicant will receive all documents in the prescribed manner chosen as indicated in the relevant section provided for on the application form in this agreement as per Section 65 of the National Credit Act. 26 It is acknowledged that if the debt under this agreement becomes incidental credit and a party wishes to refer the matter to an alternative dispute resolution agent, it must be a person as agreed between parties as per Section 134 of the National Credit Act. 27 TNU may at any time amend or replace any of the terms and conditions contained herein which amendment or replacement the Applicant / Consumer agrees to be bound by. 28 Failure by TNU to immediately enforce any of its rights in terms of this agreement, shall not amount to be construed as a waiver or abandonment of such rights. 29 Nothing in this agreement detracts from any rights that Applicant / Consumer may have in terms of the National Credit Act, in as far as it may be applicable. 30 If the metering equipment is found to comply with the system accuracy requirements laid down in NRS 057 the account would be regarded as prima facie evidence of electricity use and the onus will be on the Applicant to prove that the meter was incorrect and that the Applicant didn't used the amount of electricity as charged. I/We hereby accept the above Terms and Conditions as well as the General Terms and Conditions as determined by TNU governing the control and supply of the Utility Services required. Date: Name: Signature: Date: Name: Signature: APPLICATION FOR THE SUPPLY OF UTILITIES: TERRA NOVA 7