Form Serial No: 2303433
NEW CONNECTION APPLICATION FORM
Please fill the form in CAPITAL LETTERS (please on the appropriate box)
Notification No. XXNotification
CA No.
CONNECTION SERVICES (S) REQUIRED General
New Connection Type Meter Type
Permanent Connection Post Paid Total Area of Premises(sq.m.) : Cumulative built up area of building(sq.m.): _____
Build-Up Area of Premises(sq.m.):_______ No’s of Floor (Including Basement & Shed):_________
1 GENERAL PARTICULARS
Title Ms. Age 33 Years Date of Birth 03/09/1989
Applicant: Reena Choudhary
Relationship
Daughter Of Lt.Daya Chand
Type of Accommodation Owned ( Owned / Rental/Lease / Company Provided / Department ______________________
Govt.Provided / Govt. House / DDA Flats / CGHS Flat / J.J.Cluster / Others ) (Pls fill if tick on Govt) Division _______________________
2 Complete Supply Address
House/plot/premise no. House No 10,Floor GROUND,Premise Portion MIDDLE,khasra no 30/19/1,
Street
Other,Other,BURARI,Sector Other,Pocket Other,Phase Other,Block Other,Type Other,Category Other,
Area/colony Landmark Bhagawan Park, Jharoda Majra
Pin Code
110084
Mobile No. / Telephone No. 9718400683
E-Mail: reenadc22@gmail.com
3 Billing Address:
Same as above If different, Please specify below
Billing address
Same as above.
4. Category for Electricity Usage (As per applicable Tariff Schedule): Domestic CustomersLighting
i Domestic Category-Residential/Hospital/ Educational/ vii DJB
Institutions/ Religious/Charitable/Others
ii Non Domestic-Banks/ Chemist/ Tailors/Others viii DIAL
CIN NO. : U40109DL2001PLC111526, E-mail: customercare@tatapower-ddl.com, Website: www.tatapower-ddl.com
iii Industrial ix DMRC
iv Agricultural x Advertising (No. of Hoardings)
v Mushroom xi Charging of E-richshaw / E-vehicle
vi Public Lighting
Note: the applicant shall refer the applicable tariff schedule for correct tariff category. In case of any clarification,he applicant shall
seek help of the licensee
5. Purpose of Supply (e.g. Shop/House/ Factory/ Godown/Parking/ Public
Utility etc.
6. Total Applied Load 20 KW NA KVA
7. Contract Demand Applied KW KVA
8. a. PAN NO. : (For correct decution of TDS, if any) ALQPC0527K
b. GST NO.:
c. AADHAR NO:
d. INDUSTRIAL LICENCE NO:
9. Please indicate whether you want to purchase your own CEA approved meter having Meter Provided by TPDDL
additional features as approved by the commission.
10. List of Document attached: xxx documents
A. Photo Identity Proof submitted along with this application form > if (ii) Proof of ownership or occupancy of premises for which
applicant is a person (tick any One) electricity connection is required (tick any one)
i. Electoral Identity Card i. Certified copy of title deed
ii. Passport ii. Certified copy of registered conveyance deed
iii. Driving License iii. GPA
iv. Ration Card having photograph iv. Procession Letter/ Allotment Letter
v. PAN Card v. In case of tenant
vi. Aadhar Card a). Rent receipt (last 3 Months)/ Lease Agreement
vii. Photo identity card issued by any government agency b). No Objection certificate from Landlord
If applicant is and organization (tick applicable) Certificate of c). Proof of Ownership of Landlord
incorporation/ registration issue by the registrar. vi. Others
11. Declaration Form (Attached) Yes No
CIN NO. : U40109DL2001PLC111526, E-mail: customercare@tatapower-ddl.com, Website: www.tatapower-ddl.com
Note: (pleaseon the applicable box) Declaration
I,Reena Choudhary , Daughter Of Lt.Daya Chand Resident of House No 10,khasra no 30/19/1,Premise Portion MIDDLE,Floor
GROUND,Block Other,Pocket Other,Category Other,Type Other,Other,Other,BURARI,Sector Other,Phase Other (hereinafter
referred to as “Applicant”, which term shall mean and include executors, administrators, heirs, successors and assigns), do
hereby swear and declare as under:
Or
The , a company incorporated under the provisions of the Companies Act,1956 Or as amended,, having its registered office
at,_____________________________________________________(hereinafter reffered to as “Applicant” which expression
shall,unless repuguant to the context or meaning thereof, include its successors and assigns), through its Authorised
representative Mr. ______________________________, do hereby swear and declare as under:
Or
A sole proprietorship/a partnership firm having its office at________________(hereinafter referred to as the applicant which
unless the context otherwise provides includes its successors and assigns), through Mr.
___________________________________, who is a partner or an authorized representative do hereby swear and declare as
under:
That the Applicant is a lawful occupant of the premises at House No 10,khasra no 30/19/1,Premise Portion MIDDLE,Floor
GROUND,Block Other,Pocket Other,Category Other,Type Other,Other,Other,BURARI,Sector Other,Phase Other (hereinafter the
“Premises”).
That the Applicant has requested the Licensee to provide a service connection at the above-mentioned premises in the
Applicant’s name for the purpose mentioned in the application form.
That in furnishing the present Declaration , the Applicant has clearly understood that should any of the statements in this
declaration prove to be false or incorrect at any later stage, the Licensee shall be within his lawful right to disconnect supply to
the premises without any prior notice and proceed to adjust electricity supply dues payable by the applicant against consumer
security deposit and/or recover the same in accordance with Law.
That the Applicant has complied with all requirements under all statute for the time being in force and the Applicant himself
/herself shall be held legally responsible for any issue arising out of any such noncompliance for which the Licensee may initiate
action in accordance with applicable Law.
That I, the Applicant hereby agrees and undertakes:
1. That no objection certificate for seeking electricity connection from the co-owner has been obtained (in case the applicant is
not the sole owner of the premises).
2. To indemnify the licensee against all proceedings, claims, demands, costs, damages, expenses that the licensee may incur by
reason of a fresh service connection given to the Applicant.
3. That to the best of applicant’s knowledge, all electrical works done within the premises are as per Central Electricity Authority
(Measures relating to Safety and Electricity Supply) Regulations, 2010 as amended from time to time.
CIN NO. : U40109DL2001PLC111526, E-mail: customercare@tatapower-ddl.com, Website: www.tatapower-ddl.com
4. That the internal Wiring at the premises has been tested by a Licensed Electrical Contractor/designated officer of the
Government# and the test certificate is available with the applicant:
#in case of Government quarters/offices,
5. That the building has been constructed as per prevalent building Bye-Laws and the fire clearance certificate, if required, is
available with the applicant.
6. *That there is a provision of lift in premises and the applicant has obtained the lift fitness certificate from the Electrical
Inspector for the lift in the said premises and the same is available with the applicant.
7. That the applicant has applied for the correct category of tariff as per the applicable tariff schedule. For either of the following
categories of connection, the applicant has the relevant documents available with him.
*Applicable for selected consumer category
A. Industrial (Tick whichever is available)
a. (i) Valid Industrial License; or
(ii)Factory License; or
(iii)Household License; or
(iv)Lal Dora Certificate in case of rural village; or
(v)Any other document authorizing the applicant to run the industryOR
b. (i)Occupancy-cum-completion certificate from concerned Municipal Corporation or DDA; or
(ii) Consent to Establish from Delhi Pollution Control Committee (DPCC);or
(iii)Provisional Industrial License; or
(iv) Sanctioned building plan from concerned Municipal Corporation or DDA
B. Agricultural Consumers
i. Certificate of Residence from Block Development Officer; or
C. Non-domestic for Khokhas and Temporary Structure
i. the Bazaari Receipt Number; or
ii. No Objection Certificate for Khokha/Temporary Structure from concerned Municipal Corporation of Delhi or Delhi
Development Authority or any other concerned Land Owning Agency
Please provide following information in respect of certificate available with the applicant-
(Certificate No., issuing authority, date of issue, Purpose, validity, if applicable)
D. Charging station for electric vehicles
An undertaking by the applicant that the charging station for electric vehicles is as per the specifications as may be specified by
Central Electricity Authority or Bureau of Indian Standards from time to time.
8. *That the industrial connection is taken based on the documents mentioned in clause 7A (b) above and I shall obtain the valid
document as mentioned in clause 7A(a) above within a period of 3 months from issue of electricity connection.
*Strike out if not applicable
9. That above referred applicable documents/certificates indicated at various points are available with me and can be inspected
by the Licensee at any time. In case of failure reluctance to produce/allow the inspection of said documents/certificates the
licensee may disconnect the connection granted owing to such failure/, reluctance
10. That I shall provide a legible and certified copy of any of above applicable documents to the licensee pursuant to
order/request of any government agency, judicial forum or any other authority seeking such information.
11. That my industry/trade has not been declared to be releasing obnoxious hazardous/pollutant by any government agency and
that no orders of any Court or judicial authority would be breached by running of my industry/trade or granting any electricity
connection to the same. The licensee is indemnified against any loss accrued by the applicant on this account that on an Order
CIN NO. : U40109DL2001PLC111526, E-mail: customercare@tatapower-ddl.com, Website: www.tatapower-ddl.com
issued by a Court of law or judicial authority or any government agency for disconnection of electricity, the licensee may
disconnect the supply.
12. That I shall indemnify and hold harmless, the licensee, in case of any injury or incident on account of any fault in electrical
work in the premises and the licensee shall not be liable for any mishap or incident occurring at the premises to the applicant on
account of any faulty/defective/inferior quality wiring at the premises for which the connection is being applied.
13. To pay the electricity consumption bills and all other charges at the rates set out in the licensee’s Tariff Schedule and
miscellaneous charges for supply as may be in force from time to time, regularly as and when the same becomes due for
payment.
14. To deposit the additional security deposit and additional service line cum development (SLD) charges, if any from time to
time based on the prevailing Orders/rules, directions and Regulations of the Commission.
15. To abide by the provisions of the Electricity Act, 2003, all applicable laws, conditions of Supply/Tariff Orders and any other
Rules or Regulations as may be notified by the Commission, as applicable from time to time.
16. That licensee shall be at liberty to adjust the electricity consumption charges due/outstanding along with any other charges
against the Consumer Security Deposit paid by the Applicant, in the event of termination of the agreement prior to expiry of the
contracted period or in case of any contractual default as per provisions of regulations/rules/orders/directions of the
Commission.
17. That as per Delhi Electricity Regulatory Commission (Supply Code and Performance Standards) Regulations, 2017 or as
amended from time to time, I shall provide suitable and adequate space for installation of the meter/electrical equipments
where the licensee may have ready access to the same.
18. To allow clear and un-encumbered access to the meters for the purpose of meter reading and it’s checking etc.
19. That the licensee may disconnect the electric supply under reference, in the event of any default, non-compliance of
statutory provisions and in the event of a legally binding directive by Statutory Authority (ies) to effect such an order. This shall
be without prejudice to any other rights of the licensee including that of getting its payment as on the date of disconnection.
20. All the above declaration given by the Applicant shall be construed to an Agreement between the licensee and the Applicant.
Name of the Applicant
SIGNED AND DELIVERED
In presence of witness
Name of witness
I hereby undertake to opt for whatsapp services provided by Tata Power-DDL.
*Select whichever is applcable
CIN NO. : U40109DL2001PLC111526, E-mail: customercare@tatapower-ddl.com, Website: www.tatapower-ddl.com
