St. Kitts Electricity Company, Ltd. (SKELEC) Customer Service Department Central Street Basseterre Tel: (869) 465-2000 Fax: (869) 465-7308

Please complete as much of the following as applies to you. Note: Do not forget to sign the declaration and remember to bring photo identification (Social Security, Driver’s Licence, National Identification/Passport) when submitting this form. If you are acting on behalf of a customer you will also need to provide evidence of authority. (eg. Power of Attorney, Notarize Letter)

I, the undersigned customer of St. Kitts Electricity Company, Ltd. (SKELEC) hereby authorise and order SKELEC to perform the work requested below on the above date

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