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I hereby state that all the information I have given in support of the application above is true to the best of my knowledge and I undertake to indemnify UMEME for any costs or liability it incurs as a result of any falsehood or omission on my part. SUPPLY APPLICATION/AGREEMENT FORM District Date Application No APPLICANT S SECTION-Tick where applicable Domestic Type of Application/ Customer Type Medium Industrial Large Industrial Commercial ToU Street Light APPLICANT S DATA Surname/ Company...