Customer Consent

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)

Date(required)

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

Email address(required)

Photo ID #1(required)

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Photo ID #2(required)

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Maximum size 10MB

Request(required)

Terminate supply, close my account, and refund my deposit-net of any amounts due to SKELEC for electrical services.

Terminate supply, close my account and transfer my deposit/refund balance

Change the mailing address for all future billings and correspondence

Reactivation/Reconnection

E-Billing Request:

Please make Security Deposit check payable to(required)

Account Number:(required)

Customer Name(required)

Balance will be transferred to(required)

Amount(required)

New Address(required)

Reactivation/Reconnection(required)

Reactivation/Reconnection Date(required)

E-Billing Request(required)

E-Billing Request Date(required)

Declaration(required)

I, the undersigned, hereby release, indemnify, and hold SKELEC harmless from and against any and all claims, losses, cost and liabilities arising in any way from the execution of the above instructions.

Customer’s Name(required)

Account Number(required)

Service Address(required)

Mailing Address(required)

Date

Telephone (Work)

Telephone (Direct)(required)

Telephone (Cell)(required)

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Opening Hours

Emergency Service

Customer Service

Opening Hours

Emergency Service

Customer Service

Customer Consent