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Application for Irrigation
Application for Irrigation
SECTION A: APPLICANT’S INFORMATION
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Application Form Reference Number
*
This field is hidden when viewing the form
Approval Status
*
Submitted
Submitted
First Name
*
Middle Initial
Last Name
*
Service Address
*
Home Address
*
Mailing Address (if different from home address)
Upload copy of TRN/Driver's License
*
Accepted file types: jpg, png, Max. file size: 128 MB.
Home Number
Office / Work Number
*
Mobile Number
*
Taxpayer Registration Number (TRN)
*
Email
*
BILLS SHOULD BE SENT TO
*
Select All
Service Address
Home Address
Email
OWNERSHIP STATUS
*
Owner
Lessee
Tenant
Agent
LEGAL STATUS
*
Title
Lease
Volume No.
*
Folio No.
*
Upload Copy of Lease
*
Accepted file types: pdf, docx, Max. file size: 128 MB.
Upload Letters
*
Drop files here or
Select files
Accepted file types: pdf, docx, Max. file size: 128 MB.
Letter from Lawyer, Organizations, Justice of Peace, Tax Office, Legal/Land documents
SECTION B: PURPOSE AND TYPE OF SUPPLY
Purpose and Type of Supply
*
New Supply
Re-supply
Additional Supply
Transfer of Existing Contract
Agriculture
Industrial
Non-agricultural
Other
If Other
SECTION C: SUPPLY INFORMATION
Amount of Water Requested
*
M3/HR
Location/Description of Service Area
*
Previous/Existing Contract
*
Yes
No
Notch Number
*
Please state information of previous customer
Customer ID Number
*
Please state information of previous customer
Was the Property Previously Supplied
*
Yes
No
First Name
*
Middle Initial
*
Last Name
*
Is the Property a Sub-division of Existing/Previous Contract
*
Yes
No
SECTION D: PROPERTY DESCRIPTION
Total Area (Ha)
*
Non-irrigation Area (Ha)
*
Location of Area
*
Direction to Area
*
Crops to be Cultivated
*
Crop
With Irrigation
Without Irrigation
Hectare
Non-Agricultural Use
Type of use
Treatment of Wastewater
Yes
No
Possible Contaminant of Source
Yes
No
Name of Contaminant
Justification for Non-Agricultural Use
Applicant's Signature
*
First name
Last Name
Date
*
DD slash MM slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
