CR2A New Connection Assessment Form

TO TATOU VAI

NEW WATER CONNECTION — ASSESSMENT — Form CR2A

Phone: +682 24479 | www.totatouvai.co.ck

There is a non-refundable fee of $149.50 incl VAT payable in full at the submission of this application to TTV.

Applicant Details

Enquiry Date

Photo ID Document

Applicant Full Name *

Company (if applicable)

Email *

Landline

Mobile

Upload ID / Site Survey Plan

Property Details

Address / Location

Section Name

Estimated Date Required

Note: TTV will only try to connect if your property is within the service zone. The service zone are all areas of the island at an elevation less than 30 meters above the mean sea level mark.

Type of Development

Mains water supply role

Estimated water demand at any one time?

Declaration

I declare that the information in this application is accurate and that I am authorized to apply on behalf of the legal property owner. I acknowledge that To Tatou Vai's customer agreement will apply once the property is connected or the connection is registered and approved. I understand that providing false information may result in rejection or termination of services.

Declaration Date

Signature *