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Cat-I (Domestic) TI (Commercial & Non-Domestic) [7] ‘ViAgriculture) [_]
VI (Street Light PWS! VII (General Purpose)
VIII (Temp. Supply)
Type of Service::New Connection[_]Addl. Loaal
Category Change [] Title Transfer
To,
‘The Superintending Engineer,
Operations, APSPDCL
T/We request you to supply electricity at Low Tension to my /our premises as mentioned below:
1. a. Name of the applicant in whose name connection is
First Name Middle Name
required (IN CAPITAL LETTERS)
Sumame
b. Father’s Name / Husband’s Name
._ Location of the Premises where supply is required
House No ‘Street
Village flown Mandal
District Pin
Phone /Cell No ‘Aadhar No
Email: 'S.F No for
Agl SCs
._ Details of the supply required
a.Nature of supply
b.Contracted
Load Requested
Phase:: single phase | Three Phase
c. For adi Loads _[ SC No:
Existing Loads: ‘Adi Load Required::
a. For Category changes:: Existing
Category
Proposed
Category
b. For Name transfers:
Present
‘Consumer Name
New
Consumer
Name
. Social Group:
(please tick () in appropriate box)
Datestecssosssseeeesees Signature:
Undertaking: L/we undertake and agree to pay the (ariff and miscellaneous charges prescribed by the company and\
to abide by the General Terms and Conditions of Supply notified by the company from time to time,
which shall govern the supply of electricity to me/us in all respects.
T Ave shall undertake to execute an agreement in the prescribed form, if so called upon by the
company. Whether such an agreement is executed or not , this application itself shall oblige me us
to confirm and above by the General Terms and Condition of Supply notified by the company from
time to time.
T/we undertake to provide suitable arrangements for * way leave” at my / our own cost.
. L we undertake (0 take up any disputes arisen on account of the ownership documents produced by
me/us based on which the supply is extended and I /we also understand that merely taking of
electrical supply or payment of bills raised by the licensee for consumption of electricity will not
constitute evidence for the purpose of lawful occupation of the premises in any municipal record,
revenue record or any court of law.
Signature of applicant
0-0-0.
(to be filled by the Call Center Operator)
7. Supporting Documents enclosed
a. Completed and signed application form = { yes /No }
b, Identity Proof (any one of the :- Ration card, Aadhar Card, pass port, Election Id, PAN card etc)
{ yes /No }
¢. i, Proof of Ownership ( any of the following 1, Sale deed, 2. Allotment, Possession leter,3. Municipal
‘Tax receipt, 4. Gift deed, 5. Will deed or any other valid document) { yes /No }
OR
ii, An indemnity bond (to be executed on Rs.100/-Non-Judicial or Rs,100/- Special adhesive stamp
paper) drawn by the owner of the premises in favor of the company whereby the owner of the premises
undertakes to indemnify the company of any loss causes to the company by the applicant who is the
tenant / occupant of the premises) arising out of the release of service to the tenant / occupant.
{ yes /No }
OR
iii. Any applicant, who is not covered under (a) and (b) above , shall execute an INDEMNITY BOND
(Go be executed on Rs. 100/-Non-Judicial or Rs.100/- Special adhesive stamp paper), indemnifying the
licensee against any damages payable on account of any dispute arising out of supply of power to the
premises. He shall also pay three times of Security Deposit. {yes /No }
4d. Wiring Certificates for all LT services.
e. Name transfer form and indemnity bond for name transfer applications. { yes / No }
£. Registration Details:
Name of Seetion Registration
Nor
‘Name of Sub- Date of
Div Registration
Name of ERO Location
code
“Amount paid Receipt No
Signature of the Call Center Operator
