Annexure -1

Application form - New Connection (Low Tension Service):

1 Name of the Applicant/Organization:

2
Name of father / husband / Director / Partner /
Trustee
3 Address:
(a) For communication House/Plot/Premise no.
Street
Area/Colony
District
Telephone No.:
(b) Where the new connection is applied for House/Plot/Premise no.
existing connection is required to be shifted Street
Area/Colony
District
(Indicate landmarks to identify the location)

4 Plot size: sq. feet Covered area: sq.

feet
5 Category of Supply: (list of categories
attached)
6 Purpose of Supply:
7 Total Load applied for (in kW):
8 Type of Supply (Permanent / Temporary):
8(a) If Temporary supply, specify period of From (date):
requirement: To (date):
9 Please indicate whether you want to carry out
the works of laying service line and/or
dedicated distribution facility for the electricity
supply requisitioned (Yes/No)
10 Please indicate whether you want to install
your own CEA approved meter (Yes/No)
11 List of documents attached:
(a) Photograph affixed on application form (Yes / No)
(b) Identity Proof submitted along with this application form:
If Applicant is a person (i) Electoral identity card;
(Tick any one) (ii) Passport;
(iii)Driving license;

(v) Photo identity card issued by

Government agency;
(vi) PAN card;
(vii) Certificate from village Pradhan /
Patwari / Lekhpal / village level worker/
village chowkidar/ Primary school
 teacher/ in-charge of primary health
center etc.
(viii)Aadhar Card
If Applicant is an organization Signature of competent authority (e.g.
(Tick any one) Branch Manager, Principal, Executive
Engineer etc.) along with relevant
resolution/authority letter of the
institution concerned
(c) Proof of ownership or occupancy of premises (i) Copy of sale deed or lease deed or in
for which electricity connection is required the case of agricultural connections a
(Tick any one) copy of khasra / khatauni / khata nakal
(ii) Registered General Power of
Attorney;
(iii) Municipal tax receipt or Demand
notice or other related document;
(iv) Letter of allotment;
(v) Copy of the house registration
certificate issued by the
Panchayath/ownership certificate issued
by Revenue Authorities
(vi) Any other ownership related
document issued by local Government
Authority
(vii) An applicant who is not an owner but
an occupier of the premises shall along
with any one of the documents listed at
(i) to (vi) above also furnish a no
objection certificate from owner of the
premises;
Provided that where an applicant, who is
lawful occupier of the premises, is a
tenant or a leaseholder and is unable to
produce the No Objection Certificate
from owner for obtaining a connection, a
separate Indemnity Bond shall be
executed in favour of the distribution
Licensee in the form prescribed by the
distribution Licensee.
(viii) For bonafide consumers residing in
JJ clusters or in other areas with no
specific municipal address, the Licensee
may accept either ration card or electoral
identity card mandatorily having the
same address as a proof of occupancy
of the premises only for the purpose of
releasing electricity connection.
 Provided that if the Applicant is an
individual, the Applicant has to be Indian
Citizen for availing new electrical service
connection.

(d) Proof of current address (i) Electoral identity card;

(Tick any one) (ii) Passport;
(iii) Driving license;
(iv) Ration card;
(v) Photo identity card issued by any
Government agency;
(vi) Statement of running Bank Account;
(vii)Water / Telephone / Electricity / Gas
connection Bill;
(viii) Income Tax assessment order /
Aadhar Card
(e) Any other document as applicable (Please
Specify)
12 Any electricity dues outstanding in Licensee’s area of operation in consumer’s name:
Yes/ No
13 Any electricity dues outstanding for the premises for which connection applied for:
Yes/ No
14 Any electricity dues outstanding with the Licensee against any firm with which the
consumer is associated as an Owner, Partner, Director or Managing Director: Yes/
No
(For questions 12, 13 & 14 if the answer is ‘Yes’ in any case please provide
details on a separate sheet)
I / We hereby declare that

a) The information provided in this application is true to my knowledge.

b) I / We have read the Joint Electricity Regulatory Commission (JERC) Supply Code
Regulations 2018 and agree to abide by the conditions mentioned therein
c) I / We will deposit electricity dues, every month, as per the applicable
electricity tariff and other charges.

d) I / We will own the responsibility of security and safety of the meter,

cut-out and the installation thereafter.
e) I / We further agree that the connection given to me/us is only for
availing electricity during my occupancy and shall not be used in any
way to show ownership of premises.

Date: Signature of the consumer/ Authorized Signatory

Place: Name:
Contact No: E mail-Id:
 Note: Apart from documents for identity proof, proof of ownership/occupancy of
premises and proof of current address, the following documents shall be
attached with the application form:
(1) In case of a partnership firm -The applicant shall furnish the partnership
deed and an authorization in the name of the applicant for signing the
requisition form and agreement;

(2) In case of Public and/or Private limited Company-The applicant shall

furnish a Memorandum and Articles of Association and Certificate of
Incorporation along with Board Resolution for authorization in the name
of the applicant for signing the requisition form and agreement;

(3) Other documents applicable only for select consumer categories:

a) Industrial consumers: Valid Industrial License, if applicable
b) Agricultural consumers: No Objection Certificate from competent
government authority for tube wells, if required

c) Non-Domestic Khokhas and Temporary Structure: No Objection

Certificate for khokha or temporary structure from the nagar nigam /
nagar palika / nagar panchayat / gram sabha / gram panchayat / land
development authority / land owning agency

_______________________________________________________________________________

Acknowledgement

Application of……………………. (name of applicant) …………………

for………………………….. (purpose) is hereby received on (date).

In this regard, the applicant is given a reference no… .....to be used for
all future correspondence.

Signature/Seal of Licensee’s Representative

Name and Designation: