(Form A-2)
PASCHIM GUJARAT VIJ COMPANY LIMITED
Application form- New connection/ Load enhancement/ Load reduction/ Change of name
(High Tension/ Extra High Tension Service)
HT Connection Date of
No. Application
Note- (1) Applicant is requested to fill his/her name with all details clearly and to sign.
Further details available on website www.pgvcl.com.
For Office Use Only
SR No
M.R.No & Date
Applicant’s recent
Application No.
Passport size
Consumer No. Photograph
Contract Load
Applicable Tariff
To,
____________________ Engineer, PGVCL
____________________ Office
I / We hereby request you for New connection/Alteration in Existing Connection/ Temporary
Connection to supply electrical energy at High Voltage/ Extra High Voltage for the premises owned
/ occupied by me/ us.
1 Name of the Applicant/Organisation:
2 Name of
father/husband/Director/Partner
/Trustee:
3 Connection Type
New Transfer Addition / Reduction in
Load
Name of the original
Consumer:
4 Address for communication
5 Address where the new connection is
applied for/existing connection is
required to be shifted
(Indicate landmarks to identify the
location)
6 Voltage at which supply is required (kV) 11 kV 66 kV 132 kV 220 kV 400 kV
(Please tick the category applicable)
7 Type of supply (Permanent/
Temporary)
7 If Temporary supply, specify period of From (date):
(a) requirement
To (date):
8 Details of Contract Demand applied for
(in kW/ kVA):
9 Power requirement in kW/kVA Change in Contract Demand
New
Connection Existing Additional/ Revised C. D
C. D. Reduction
10 Tentative date from which power
supply is required
11 Purpose of Installation Manufacturing of goods/ Service
12 Category of tariff opted for
13 Basis for projection of Contract
Demand- Diversity Factor assumed
14 Production capacity
15 Number of shifts working
16 Legal Status of the applicant
(viz. Ownership/ partnership/ Private
Ltd./
Public Ltd./ Society/ Govt Dept./ Govt.
Undertaking)
16 Registration No. and Date
(a)
17 Name of Institution developing
Industrial Premises
18 Possession Letter or No-Objection Number: Date:
Certificate
19 Issued by the Institution (attach a copy)
20 Whether the above unit ever operated (a) Sanctioned Load:
at some other place or applied for
connection? (If yes, please provide (b) Connection No.:
details) (c) Arrears of payment (if any):
21 If electricity connection for the (a) Sanctioned Load:
premises was requested in the past? (If
(b) Connection No.:
yes, please provide details)
(c) Arrears of payment (if any):
22 Status of land acquisition
23 Whether the requisite consent/ NOC (if
applicable as per the list of Pollution
Control Board) has been obtained
from_______________ as per statutory
requirements (If yes, attach a copy)
24 Any electricity dues outstanding in licensee’s area of operation in consumer’s name: Yes/ No
25 Any electricity dues outstanding for the premises for which connection applied for : Yes/ No
26 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 24,25 and 26 if the answer is ‘Yes’ in any case, please provide details on a separate
sheet)
Declaration
I/ We hereby declare that
(a) The information provided in this application is true to my knowledge.
(b) I/We desire and agree with the distribution licensee to avail power supply for the
above mentioned purpose and of the load shown in this application form for the
period of two years from the first day of the month next to date of commencement of
power supply by the licensee.
(c) I/ We have read the GERC (Gujarat Electricity Supply Code) and agree to abide by the
conditions mentioned therein.
(d) I/ We will deposit electricity dues, every month, as per the applicable electricity tariff
and other charges.
(e) I/ We will own the responsibility of security and safety of the meter and metering
equipments and the installation thereafter.
Date: Signature of the consumer/ Authorized Signatory
Place: Name:
In case of Firm/ Partnership/ Ltd. Company, Power of attorney Holder’s signature must be
supported by official seal
Note: The following documents shall be attached with the application form:
1. Proof of ownership of the premises
2. A map indicating the proposed location of the plant/ office and the point where supply
is required. The map should also clearly show all the boundary of the premises, the
public road/s (with name/s of the road/s) inside and outside of the premises/ land,
roads, lands, roads belonging to outside agency innerving the premises, if any.
3. License/ NOC from statutory authority, if required or a declaration by the applicant
that his connection does not fall under the requirement of NOC under any statue.
4. In case of a proprietary firm, an affidavit to be submitted stating that the applicant is
the sole proprietor of the firm.
5. In case of partnership firm, partnership deed.
6. In case of Limited Company, Memorandum and Articles of Association and Certificate
of Incorporation.
7. Proof of permanent residential address of the consumer and PAN Number, if any. If
there is any change at a later date, the same shall be intimated by the consumer to the
licensee immediately.
8. Letter of intent for production/ enhancement in production may be furnished.
9. List of equipments proposed to be installed along with the expected load.
10. Resolution for authorized signatory.
11. Registration from Industries Department.
12. Extract of project report relevant to power and process requirements ( in case of
industries)
13. Copy of the relevant section of the current tariff order that provides details of the
tariff category opted by the consumer and duly signed by him. This will be appended
with the agreement after completion of formalities.
