A. Your Brief Introduction

(To Know you better and serve effectively, please provide your contact options)

1. Customer Account Number*

2. Name On Bill*

3. GSM Number*

4. Email*

5. Name Of Occupier*

6. OccupierGSM Number*

7. Occupier Email*

8. Owner Of Permise

9. Permise GSM Number*

10.Permise Email*

11. Billing Address

Locality

LGA*

STATE

12. If you would like to change the Name on Bill

B. Estimation of your load and supply requirements

(In order to establish a robust network to provide you with quality and uninterrupted power supply, please provide your information as requested below)

1. Daily Receive Power (Hours)

2. Timeslots when supply of electricity is most convenient / required
 6am-10am  10am-5pm  5pm-10pm  10pm-6am

3. What is the electricity supply used for in your premise  Residential  Shop  Eatery  Bank  Hotel  School  Office  Religious Establishment

4. Brief description of connected fixtures and appliances(Please fill the no. of appliances in appropriate box)

Bulbs

Mixer/Grinder*

Water Heater

Fan

Electric Cooker*

Air Conditioner

Refrigerator

Television

Pressing iron*

Microwave Oven

Other appliances

C. Your Service Expectations

(In order to understand your service needs and preferences, please provide the following details)

1. Please select options for receiving bills  Delivery to house  Delivery by email  Delivery by text  Through Website

2. Mode of bill payment(Please check all preferred methods of payment)  Cash at BEDC office  Cash deposit at nearest bank  Cheque  Point Of Sale Terminal (POS)  Debit card/ATM  Online payment

3. Nearest bank branch to your premise

4. Do You have a meter at your premise  Yes  No

5. Metering type in your premise  Pre Paid Meter  Credit meter

6. Is your meter reading taken every month (In case of credit meter)  Yes  No

7. If "No", Interval of meter reading

D. Existing Issues/complaints

In order to understand the existing issues with the company, please provide a list of your complaints/issues within the last 6months
1. Nature of issue/ complaints
a)

b)

c)

d)

2. Suggestions to improve our services

3. Name of customer/occupier


4. Signature :


6. Photo Of user/Occupier :


5. Date




About Us

Benin Electricity DisCo (“BEDC” or “Benin Disco”) is one of the successor distribution companies created following the unbundling and privatization of the state-owned Power Utility, Power Holding Company of Nigeria Plc.

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