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Add your contact information

Name of Claimant

First Name *
Last Name *

Address *

Telephone Numbers

Home Number

Office Number

Mobile Number *

Email *

Identification (National ID or Passport) *

Upload digital copy of the requested document. You can scan or take a photo of the document for upload.

Name of Account Holder *

If you are not the account holder:

Relationship to Account Holder *

Account Number *

Meter Number *

Date of Occurence *

Add date e.g Mar 9, 2020

Time of Occurence *

Add time e.g 10:30am, 11:50pm

Call Centre Reference Number *

Reference number assigned to you when report was made

Briefly described what occured *

Particulars of damaged equipment

Click on + to add equipment to list. Click on - remove equipment from list.

Equipment *

Brand *

Model*

Age *

Capacity(Watts) *

Details of the equipment defect *