ANNEX 2

REGISTRATION FORM FOR MINI-GRIDS BELOW 100 KW

(Pursuant to S. 8 (1) (b) of the NERC Regulations for Mini-Grids, 2016)

IMPORTANT NOTES Your Registration is incomplete unless all required documents are submitted.

NERC reserves the right to verify the accuracy of this information.

In compliance with the NERC Mini-Grid Regulations, 2016 I am herewith certifying that I have commissioned a Mini-Grid system of up to 100 kW of Distributed Power on 15/12/2017

I hereby apply to register my project as a Mini-Grid below 100 kW.

1.0 PARTICULARS OF APPLICANT AND CONTACT PERSON

Name of Applicant:

Physical address:

Postal address:

Tel:

Fax:

Mobile Phone:

E-mail:

Website Address:

Name of Contact Person:

Mobile Phone of Contact Person:

E-mail for Contact Person:

2.0 LEGAL STATUS OF APPLICANT

2.1 Indicate legal status of Applicant (Tick relevant option)

(Attach Certificate of Registration, Certificate of Incorporation,Memorandum and Articles of Association, Deed of Partnership, Deedof Trust, as applicable)

3.0 NATURE OF APPLICATION

3.1 State whether Application is a fresh Application or Renewal

3.2 Existing Permits/Licences/Tripartite Contracts

Does the Applicant have an existing Permit or Licence and/or Tripartite Contract issued by the Commission for other systems?

If yes, state the nature of the Permit/Licence/Tripartite Contract, date issued and the Permit/Licence/Tripartite Contract number.

Date issued:

Contract number:

3.3 Refusal, Suspension or Cancellation of Permit/Licence/Tripartite Contract

Has the Applicant ever been refused a Permit/Licence/Tripartite Contract or had its Permit/Licence/Tripartite Contract suspended and/or cancelled by the Commission?

If yes, give details of the refusal, suspension, and/or cancellation.

4.0 MAIN BUSINESS ACTIVITIES OF APPLICANT

Please indicate the main business activities the Applicant is currently engaged in.

5.0 DESCRIPTION OF PROJECT

5.1 Site of the Mini-Grid (State, Local Government Area, Ward, Village)

State:

Local Government Area:

Ward:

Village:

(Attach title document to the land, relevant maps and drawings)

5.2 Generation

Type of system Size in kW
Generation

kW

kW

kW

kW

kW

Total: kW

Storage kW
Inverters kW

Location of the Power Plant (geographical coordinates in Degrees, Minutes, Second. e.g. Lat : 9°4'0.00"N - Long : 7°28'60.00"E):

Latitude: Longitude:

Is the Power Plant new? If no, please state number of years the plant has been in operation

Number of years of operation:

5.3 Distribution

Type of system Size of system
Lines

metres

metres

metres

metres

Total: metres

Type of Lines

Poles

poles

poles

poles

Total: poles

Transformer

kW

Length of distribution network (indicate geographical coordinates of four reference points)(geographical coordinates in Degrees, Minutes, Second. e.g. Lat : 9° 4'0.00"N Long : 7°28'60.00"E):

Latitude of point 1: Longitude of point 1:

Latitude of point 2: Longitude of point 2:

Latitude of point 3: Longitude of point 3:

Latitude of point 4: Longitude of point 4:

5.4 Customers

Number of customers:

5.5 Revenue and Sources of Funding

Expected electricity sales [kWh/year]:

Electricity tariff [NGN/kWh or flat rate per W]:

Share Capital contribution (specify foreign or local):

Loan capital (specify source and provide evidence):

Others (specify):

DECLARATION BY THE APPLICANT

The project is not unlawful or contrary to the interest of the Federal Republic of Nigeria, provisions of the Electric Power Sector Reform Act and relevant NERC Regulations. hereby declare that the details stated above are, to the best of knowledge, true and correct.

Dated this day of

THE COMMON SEAL OF THE WITHIN NAMED APPLICANT

Has hereunto been affixed in the presence of:

Sign: Sign:
Name: Name:
Designation: Designation:

Sworn to this day of at

BEFORE ME

NOTARY PUBLIC/COMMISSIONER OF OATHS