HPSEBL Form CS-1 (a)

HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED

(A STATE GOVERNMENT UNDERTAKING)
Application and Agreement Form for Domestic Electricity Connection.

Application No. Connection No. Date of Receipt Signature of HPSEBL Official

(Note:- The applicant should hand over this A&A form to local office of HPSEBL in the area in which the
supply is required along-with a non-judicial stamp paper of Rs. 50/- dully crosses with words “Agreement for
supply of Electricity/Power” on stamp paper)
The Assistant Engineer/Assistant Executive Engineer/Executive Engineer,
Electrical Sub- Division, HPSEBL Limited,

Sub:- Application and agreement for new connection/revision of load/change of name for
domestic electric connection.
A) Particulars of Applicant/Consumer & premises
i) Name of applicant..................................
ii) S/o, D/o, W/o..........................................age...........
iii) Adhaar No(optional)…………………..
iv) Mobile No…………………………… Tel. No…………………………
v) Email………………………………………………………………….
vi) The wiring work will be/has been carried out by (Name of licensed
contractor/wireman)............................................................
Full Address of Premises where connection is required:
House /Plot No. Village /Town/City
Floor No District
Landmark Pin Code
Sector/Colony/Street Whether MC/NP/TCP
area (Y/N)
Description of premises [ No of rooms,
floors, other area where supply of to be
given]
B) Details of load/class of application etc.
i) Schedule of energy consuming apparatus to be connected:
Description Lamps, Tubes etc. Fans Heaters and Motors
of Refrigerators etc.
apparatus
No. Total No. Total No. h. p. each Total KW
Wattage

Wattage

kW kW
1-Ø 3-Ø 1-Ø 3-Ø

1 2 3 4 5 6 7 8 9 10 11 12

Total
[In case of Extension in load, the existing & additional Load is to be indicated separately]

ii) Total Connected load(kW) of above installation (4+7+11+12) .......................... kilowatts

Existing ……………………………(kW) Addl./New......................... (kW).

iii) Voltage at which supply would be preferred ....................... kV

iv) Details of other connections existing in the name of the applicant

a) Account No. ……………………………….b) K. No………………………………………….
c) Category……………………………………………………………………………………………
v) Type of Application:
(a) A new connection: ............................................
(b) An extension to my/our existing installation (connection A/C No ......................... )
(c) A re-connection (the previous consumers' name is .............................................
and his connection A/c No. is .................................................................. )
P.T.O.
 [2]-CS-1(a)
(d) A change of name/title from Shri..................................Connection A/C
No..........................
(e) Change of Supply voltage for existing connection A/C
No……………………………………….
(f) Other(please mention)…………………………………………………………
vi) Approximate date from which connection is required........................................
C) I/We do hereby solemnly affirm /declare and agree as under:-
i) That I/We am/are the legal owner(s)/occupier of house/plot/premises mentioned at Sl. No. A(vi) (
hereinafter referred to as ( “The Premises”), in support of which the applicant(s) has enclosed proof of
occupancy/ownership.
ii) That I/We have applied to Himachal Pradesh State Electricity Board Ltd. (HPSEB Ltd.) ( “ The Licensee”) for
electricity connection at the above mentioned premises for the purpose mentioned above and I /We agree
to take supply of electricity for the domestic purpose only.
iii) That I/We undertake to pay Security as per HPERC(Security Deposit)Regulations,2005, the charges towards
Recovery of Expenditure for supply of Electricity as per HPERC(Recovery of Expenditure for supply of
Electricity) Regulations,2012 and its amendments issued from time to time with the time period as
mentioned in the regulations and further undertakes to pay all energy charges and other service charges as
per tariff order determined by Himachal Pradesh Electricity Regulatory Commission(HPERC) applicable from
time to time. That in case I/we fail to deposit the charges within stipulated period, HPSEB Ltd. is at liberty
not to release the electric connection/not to allow the extension of load/disconnection of supply to the
above mentioned premises.
iv) That I/We undertake to accept and abide by the provisions of Electricity Act,2003, all applicable laws,
conditions of supply, General Conditions of Tariff and Schedule of Tariff, Supply Code, rules, regulations
including Safety Regulations by CEA, orders, Directives, Notifications issued and enforced under applicable
laws by HPERC/CEA/Govt. of India/Govt. of HP and any other instructions/circulars issued by HPSEB Ltd.
from time to time, and as amended from time to time, for equitable and efficient distribution of electric
energy. These are also available on website of HPSEBL and HPERC i.e. www.hpseb.com & www.hperc.og.
v) That I/we shall be solely held responsible for contravention, if any, of Act/ Law of any statutory authority/
Central/ State Government Department and HPSEBL shall not be made party on any omission/
contravention by me/ us. Any loss on this account shall be my/ our liability.
vi) That I/We undertake to indemnify the licensee against any loss accrued to the Licensee if the
declaration/undertaking furnished by me/us prove to be false/incorrect or are unfulfilled. I/We further
undertake to indemnify the licensee of any harm/loss to the Licensee’s property for any loss/harm to any
third party on account of any fault in the electric work at my /our premises. Further, applicant agrees that if
there is any harm/loss to the property of the Licensee, due to the fault of the electrical network within the
premises of the Applicant, all the liabilities shall have to be borne by the applicant.
vii) That the Licensee shall have the right to supply electricity to other consumers from the service line or
apparatus installed on my/our premises as per Supply Code/HPERC Regulations.
viii) That grant of the applied electricity connection will not confer any legal right for regularization of
building/land use in respect to the electricity connection provided at the Applicant’s premises. Further, it
shall also not confer any right in favour of Applicant to have permanent electricity connection.
ix) That the applicant would allow clear and unencumbered access to all authorized officials of the Licensee to
the premises of the Applicant for the purpose of meter reading, maintenance, inspection, checking, testing
etc.
x) That I/We have clearly understood that if the above statements prove to be false or incorrect or on receipt
of a reference/notice from concerned statutory authority/ law enforcing agency of State /Central Govt.
regarding sealing/demolition/vacation of the premises/ contravention of any of the bye laws, the electricity
connection can be disconnected and the meter /service line can be removed by HPSEB Ltd. without any
further notice to me.
This agreement for the connection shall be effective from the date the connection is released and shall remain
effective till such time as it is either replaced by fresh agreement or it is terminated as per provisions of H.P. Electricity
Supply Code.

Date: - - /- -/- - - -/ Signature of Applicant

Signature of Witness
Name of witness............................A/c No..............................
Address of Witness .............................................................
…………………………………………………………………………………………………
Signature on behalf of HPSEBL
Name & Designation………………………………………………………………………….
(To be signed by load sanctioning authority)
Note: The consumer who intends to apply for Net Metering , the application shall be made on Form-1 and
agreement shall be executed on Form-2 of HPERC(Rooftop Solar PV Grid Interactive Systems based
on Net Metering)Regulations,2012. The agreement executed on Form-2 shall be supplementary to the
agreement on A& A form.
 [3]-CS-1(a)
(FOR OFFICE USE ONLY)-Domestic
Name of Consumer:
1) a) Standard Supply Voltage .............................. Volts b) Availed Supply Voltage…………..
c) Metering Voltage……………………………………………….
2) Name of Feeding Sub-Station………………………………………..
3) Category applicable as per Tariff Order : Domestic
4) Details of Amount deposited by the applicant:-
a) Security deposit
Sr. Amount Receipt Dated Purpose[New load/addl. Load/revision Signature of
No. No. of security based on average tariff] official
i)
ii)
b) Normative IDC
Sr. Amount Receipt Dated Purpose[New load/addl. Load/revision of Signature of
No. No. security based on average tariff] official
i)
ii)
c) Cost of Service line/Estimate
Sr. Amount Receipt Dated Purpose[New load/addl. Load/revision of Signature of
No. No. security based on average tariff] official
i)
ii)

5) Accepted/Sanctioned/ Recommended[ Please Tick ] Signatures……………….

Comments/recommendations Designation AAE/AE/AEE
Dated:……………………….
6). Sanctioned /Recommended[ Please Tick ] Signatures…………………
Comments/recommendations Designation Sr.EE/ASE

………………………………………………………………………………………………Cut here…………………………………………………………………………………………………………………..

ACKNOWLEDGEMENT
HPSEB Ltd.
Date Name of Applicant Tariff Category Application No. Load(kW)
Domestic(DS)
(Signature of Authorized person of HPSEBL)
 Checklist for Domestic Consumer[CS-1(a)]
Sr. Description Please
No. Tick 🗸

A) General
i) Application and Agreement Form (A&A Form) duly completed and signed by the
applicant.
ii) Test Report duly filled and signed by licensed Electrical Contractor.
iii) Crossed Non-Judicial Stamp paper of Rs.50/- attached with A&A form
B) Identity/Ownership
i) Identity Proof ( any one of the documents given below)
PAN
Adhaar Card
Driving License
Passport
Voter ID Card
ii) Proof of Ownership outside TCP/MC/NP/ other ULB areas ( any one of
the documents given below)
Revenue Papers for Land/Building/premises
Sale Deed
Lease Deed
Proof of Ownership within TCP/MC/NP/ other ULB areas
NOC from TCP/MC/NP/other ULBs
C) Charges to be deposited[Ref. HPERC Regulations 419/2012,HPERC Security Deposit
Regulations,2005] and their amendments from time to time.
i) Initial Security
ii) Normative IDC
iii) Cost of Service Line or Departmental Charges as the case may be.
 HPSEBL Form CS-10( Page-1)
HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED
(A STATE GOVERNMENT UNDERTAKING)
WIRING CONTRACTOR'S TEST REPORT
AND
HPSEBL'S INSTALLATION TEST ORDER
Name and Address of Premises where connection is required:
Name of Applicant ………………………Address ............................................................ Description
of Premises………………………………………………………………………………………………………………..
From (Wiring Contractor)
Name and Address:……………………………………………………………………..
……………………………………………………………………………………………….
License No…………....... Dated --/--/---- Valid up to --/--/----.
To
The AE/AEE/EE/ ESD, HPSEBL ………………….
REPORT

We hereby inform that Electrical Installation at the premises belonging to the

above consumer, as detailed on page 2(backside) is now ready for your engineer to test and
connect up with your mains. The installation was tested by me/us on.......................................
(date) and the insulation resistance was as shown at page 2.

Dated:_ _/_ _/_ _ _ _/ Wiring Contractor's signature..............................

HPSEBL’S INSTALLATION TEST ORDER

(A)
The Junior Engineer/ Addl. A.E, Electrical Section, HPSEBL

Please test the installation detailed on pages 2, fill in columns 18 to 22 and report as
below. It may, however, be ensured that the intimation regarding the date on which you intend to visit the
consumer’s premises for the above said purpose is given to the consumer or his representative well in
advance, so as to enable him to be present at the time of Inspection. Also please ensure that for any
subsequent visit for testing of the said installation necessitated by the consumer on the previous visit or due
to defective installation, the consumer is asked to pay the requisite charges as per the schedule of general &
service charges and receipt No./date vide which the charges are paid by him is quoted in the report.

Assistant Engineer /Assistant Executive Engineer

Dated ………………………….
(B) REPORT
(1) Above installation was tested by me on (date) .................................. in the presence of consumer (or
his representative) and the insulation Results were as shown on page 2. The following defects were
found in the installation.
i) Whether Insulation Resistance Satisfactory…………………………………
ii) Other Defects, if any (a)…………………………………………………….
(b)……………………………………………………
(c)……………………………………………………
(2) (a) The above installation was tested by me on my first visit.
OR
(b) The installation was tested by me on my subsequent visit for which the consumer
deposited the amount of Rs .......................... as per the schedule of general & service charges
vide Receipt No……………………….Date………………

Signature of Consumer
Name( in case of representative): ………………
Dated:_ _/_ _/_ _ _ _/ Signature
Junior Engineer/Addl. A.E.
Dated:_ _/_ _/ _____ /
P.T.O.
 SCHEDULE OF ENERGY CONSUMING APPARATUS TO BE CONNECTED HPSEBL Form CS-10( Page-2)
Description Lamps / Fans, Heaters, Motors INSULATION RESISTANCE [MEGA-OHMS]

Earth Resistance(in Ohms)]In case of Medium, HT&EHT

Tubes Etc. Cookers,
Refrigerators etc.
No. of Circuits (left to Right) on Distribution Board

No. Total No. Watts Total No. h.p/ Total kW Wiring Contractor’s HPSEBL Test
kW each kW kW each Test

Total connected load of each circuit (in kW)

1-Ø 3-Ø 1-Ø 3-Ø

& earth

& earth
Between

Between

Between

Between
Conductors

Conductors
Conductors

Conductors
lamp or apparatus

lamp or apparatus

lamp or apparatus

lamp or apparatus

lamp or apparatus

lamp or apparatus
After connecting any

After connecting any

Before connecting any

Before connecting any

Before connecting any

Before connecting any

Size of Conductor

installations
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
No.1

No.2

No.3
No.4

No.5

And so
on ……..

Load verified for ............................... (kW) The Size of connecting wires

Between Meter Board & Dated Signatures of the
Dated Signature of Verifying Officer/Official Distribution Boards …………… .Wiring Contractor ………………..
Name & Designation of Verifying Officer/Official……………….
…………………………………………………………………………..