333-2186
226-2600
Supenaam – Charity 623-4014 | 623-0123 Bartica 623-5012 | 608-8541
Wakenaam 623-5013 | 623-4012 Leguan 623-5017 | 608-8543
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Name of Claimant
Address *
Telephone Numbers
Home Number
Office Number
Mobile Number *
Email *
Identification (National ID or Passport) *
Name of Account Holder *
Relationship to Account Holder *
Account Number *
Meter Number *
Date of Occurence *
Time of Occurence *
Call Centre Reference Number *
Briefly described what occured *
Particulars of damaged equipment
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