Appendix I

Application for Supply of Electricity at High Tension (to be submitted in 5 sets)

Registration No.: Registration Date:

Amount Paid Rs: DD No.: DD Date:

To

(Designated Officer)

I/ We request you to supply electricity at High Tension as mentioned below:

1a. Name of the Customer in whose name connection is required:

1b. Status of the consumer:

Individual Registered Partner Ship Unregistered Partner Ship

Private Company Limited Company Any Other Government

2. Location of Premises where supply is required:

Door No.: Street:

Mandal: Village:

District: PIN Code:

3. Addresses and Mobile Number for Communication:

Address for Communication:

Mobile No:

Email ID:
4. Type of Service required (Please tick the service applied for):
New Service

Additional Load (Alteration / Extension to existing installation)

Load Deration Load Restoration Term Restoration

Title Transfer
Change of Category:
Existing Category : Proposed Category:

5. Category of Supply Requested (Please tick the category required):

Category Purpose

HT-I Industries

HT-II Commercial & Others

HT-III Railway /BUS Stations & Airports

HT-IV Irrigation & CPWS

HT-V Railway Traction
HT-VI Townships & Residential Colonies

HT-VII Temporary
HT-IX Electric Charging stations

6. Are any other services existing in the same Premises: Yes No

If yes, details thereof are as follows:

S. No. Particulars Details

i Existing Service Connection Number

ii Existing Contracted Maximum Demand
(KVA)
iii Existing Contracted Load (HP/KW)

iv Existing Connected Load (HP/KW)

v Date of conclusion of present Agreement
vi Date of release of supply
vii Security Deposit
 7. Are any other services existing elsewhere in the same name or in the
Names of sister concerns: Yes No
If yes, details thereof are as follows:

Service Connection Number Category

8. Requirement for New Service:

i Contracted Maximum
Demand(KVA)
ii No. Of Phases & Details
(With Phasing if any)

iii Contracted Load (HP/kW)

iv Independent Feeder (Yes/

No)

9. Details connected at the time of commencement of supply:

10. Nature of industry and product manufactured:

11. Number of running days in a month:

12. Number of running shifts of the factory:

13. Period of season if load is seasonal:

No.of Seasonal Months : ________________ (min. 4 Months)

Starting month: ________________ End month: ________________

14. Date by which service is required:

15. Power of Attorney:
16. PAN Number:
17. GST Number :

18. Any other information:

19. Supporting documents enclosed (Please tick here applicable):

 Documents to be furnished

Contracted Load Details (Where available)

Memorandum of Understanding

Articles of Association, Partnership Deed

Site plan indicating the Proposed receiving Points of Power
Supply from the Company

General Power of Attorney

NOC from Local Body (E.g. Gram Panchayat or

MCH)
Consent from TS Pollution Control Board (If Applicable)

SS1 Certificate (If applicable)

Industrial License

Employment Potential

Financial Assistance

Line Of Manufacture

Letter for Undertaking Capital Works on Turnkey Basis

(Optional)

Certification of Incorporation

Occupancy Certificate( HT-II)

I/We request the company to provide meter/metering equipment for measuring

electricity supplied to me.

I/We undertake to execute an agreement in the prescribed form, if so

called upon by the Distribution licensee.

Signature of Applicant Signature of Original Owner

 Place Date

20. Signed by the Applicant in my presence:

Witness1: Witness2:
Signature: Signature:

Name And Address: Name And Address:

Date: Date: