Caribbean Utilities Company, Ltd. Customer Service Department P.O. Box 38, Grand Cayman KY1-1101

Tel: (345) 949-5200, Fax: (345) 945-1218

CSD May 2020

Customer Directive/Service Termination Form

Email: service@cuc.ky, Website: www.cuc-cayman.com

Customer Account Information and Contact Details

Customer’s Name [as it appears on bills]:

Account Number: [or Meter Number]:

Service Address:

Mailing Address [PO Box}: KY1 -

Primary Email Address: Secondary Email Address:

Primary Contact Number: Secondary Contact Number:

I hereby authorize and direct Caribbean Utilities Company, Ltd. to:

Terminate electrical service at the address below & charge the card details provided (page 3) for any amounts owed to CUC.

If a credit balance remains on the account after application of the deposit:

Refund deposit by way of a KYD cheque mailed to the PO Box on file.

Refund deposit by way of direct deposit to my local bank account using the following details:

Beneficiary Account Name: CI$ Checking

Beneficiary Bank Name: CI$ Savings

Beneficiary Bank Account No. US$ Checking

Transit No. (RBC or Scotia) US$ Savings

Transfer deposit/balance to another CUC account:

CUC Account Number: Customer Name: Signature of customer that balance will be transferred to:

Automatically reactivate my account to avoid an interruption in service at:

E-Billing: Send monthly bills via email to:

Other Notes or Instructions:

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Other Service Requests:

Change mailing address for all future billings and correspondence to: P.O. Box KY1-

I understand that I will be charged a final bill amount, from the date of my last electrical bill, through the requested

date of termination.

Effective date of termination(Please note that termination times cannot be scheduled and may begin as early as 8:00 am)

Privacy Notice:

Personal information collected by CUC is accessible only by authorized personnel and is used for connection of electricity services, notifications relating to your electricity account(s) and distribution and collection of other relevant information affecting service(s). For further details please review our full Privacy Notice which can be accessed at any time via our website at www.cuc-cayman.com CUC will contact customers to notify of imminent disconnection and outages. Information is also shared with third parties in relation to the collection of funds, both for current and overdue balances. It is the customer’s responsibility to notify CUC if contact details have changed.

Declaration

I, the undersigned, hereby release, indemnify, and hold CUC harmless from and against any and all claims, losses, cost and liabilities arising in any way from the execution of the above instructions. It is further understood that the undersigned will be liable for all unpaid amounts and authorizes CUC to transfer any outstanding amount to any of the undersigned’s active CUC accounts.

Signature of Additional Account Holder:

when submitting this form. If you are acting on behalf of a customer you will also need to provide evidence of authority. Accounts may only be set to automatically go back to the name of the owner, and will require a security deposit to ensure no interruption of electricity service. Service fees may apply.

For Official Use Email verified (same as on file) ID on file and valid Contact Details up to date Signature(s) the same as account holder (or authorization on file)

Please Verify:

1. Is there a DD light at this location? Yes No 2. Should the light be disconnected, and removed? Yes No

3. Should the DD light be transferred to another customer? Yes No

4. What is the new customer Account # and Contact details:

Account information checked/verified by:

Name of Customer Service Representative:

Signature: Date:

Return signed form to CUC, Customer Service Department, P.O. Box 38, Grand Cayman KY1-1101, or via E-mail: service@cuc.ky

Customer’s Signature [or signature of legal personal representative]:

If acting on behalf of a customer as his/her legal or personal representative, you must also provide the following documents: a] If a Customer is deceased and has left a will: [1] a copy of the death certificate and [2] a probate copy of the will.

b] If a Customer is deceased and has NOT left a will: [1] a copy of the death certificate and [2] a copy of the letters of

administration. c] In the case of a living Customer: [1] a copy of the Court documents or Power of Attorney granting

authority to you or [2] a signed letter giving permission for you to act on behalf of the account holder, along with Photo ID of the account holder

Note: Please ensure that the declaration is signed and a valid photo identification (driver’s license or passport) provided

Date of request:

Note: Forms submitted with digital signatures must be accompanied by two types of photo ID

Caribbean Utilities Company, Ltd. Customer Service Department P.O. Box 38, Grand Cayman KY1-1101

Tel: (345) 949-5200

One-Time Credit and Debit Card Authorization Form

E-mail: service@cuc.ky, Website: www.cuc-cayman.com

Transaction Type

How it works:

1. Complete this Credit and Debit Card Authorization Form and provide it to CUC along with a photo ID. 2. The submitted form will be processed for the indicated purpose/amount and confirmation sent by email

Name as it Appears on the Card:

Card Billing Address:

Mobile: Home/Work: E-mail:

Privacy Notice:

Personal information collected by CUC is accessible only by authorized personnel and is used for connection of electricity services, notifications relating to your electricity account(s) and distribution and collection of other relevant information affecting service(s). For further details please review our full Privacy Notice which can be accessed at any time via our website at www.cuc-cayman.com CUC will contact customers to notify of imminent disconnection and outages. Information is also shared with third parties in relation to the collection of funds, both for current and overdue balances. It is the customer’s responsibility to notify CUC if contact details have changed.

Declaration and Signatures:

I confirm that I wish to utilize the below listed credit/debit card to pay my final electricity bill[s] and/or security deposit as a one-time transaction. This form gives CUC the authority to charge my credit/debit card for the total amount of my final bill[s] and/or security deposit with respect to the electricity account number below.

CUC Account No.: Name of Account Holder(s):

Credit or Debit Card Number: Expiration Date: /

Visa MasterCard Discover US$ CI$

I authorize CUC to charge the credit/debit card indicated in this authorization form according to the terms outlined above. I understand that this authorization relates to a one time transaction only. I certify that I am an authorized signatory for this credit/debit card and that I will not dispute the payment with my credit/debit Card Company or bank; provided the transactions correspond to the terms indicated in the authorization form.

Signature[s] of card holder(s):

Print Name[s]:

Date:

Final Bill Payment Security Deposit CORE Applicaton

CSD May 2020