Application form –High Tension Service Connection
New Connection/ Shifting of Premises/ Change in Contract
Demand/ Change of Tariff Category / Change of Name of Consumer
(Please strike-off the purpose that is not applicable)
To,
_____________________________
_____________________________
_____________________________
_____________________________
Sir,
I/
We request you to supply electricity to my/ our premises. The requisite information
is furnished below:
1
Consumer
(a)
Name of the person/ organization : ________________________________
(b)
Name of father/ husband/ Director/ Partner/ Trustee :
______________________________________________________________
(c)
Full Address of the premises where a new connection is hereby applied for/ the
existing
connection is proposed to be shifted:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
PIN
: ________________
Telephone
No :
Mobile
No. consumer/ Manager Incharge:
Factory/
Premises : __________________
Registered
Office : __________________
Residence
: __________________
E
mail : ____________________________________
Bank
A/C No. (optional) : ____________________________________
2.
Voltage at which supply is required:-
|
11
kV |
33
kV |
132
kV |
220
kV |
(Please
strike-off category not applicable and tick the category applicable)
3
Type of supply : Permanent/ Temporary
(Please
strike-off type not applicable and tick the type applicable)
If
temporary, specify period - From:________________ To: ___________________
4
Steps taken by the consumer so far to set-up the installation
(a)
______________________________________________________________
(b)
______________________________________________________________
(c)
______________________________________________________________
(d)
______________________________________________________________
5 Basis
of projection of Contract Demand required
(a)
Diversity factor assumed : _____________________________________
(b)
Total Connected Load : _____________________________________
6
Phasing of contract demand (CD
|
Sl
No |
CD
required (kVA) |
Tentative Date
from which required |
Remarks |
7
Purpose of installation : _____________________________________
8
Category of tariff opted for : _____________________________________
9
Production capacity : ________________________________
10
Category of Industry : SSI/ MSI/ LSI
(Please
strike-off category not applicable and tick the category applicable)
11. Status of land acquisition : _____________________________________
_______________________________________________________________________
______________________________________________________________
12
Expected date by which finance would be available:
______________________________
13
Whether the requisite consent / NOC (where applicable according to the list of
Pollution
Control Board) has been obtained from MP State Prevention and Control of
Water
Pollution Boards, Bhopal as per statutory requirements (If yes, a copy should
be
furnished). : ____________________________________________
14
Any electricity dues outstanding in licensee’s area of operation in the
consumer’s
name:
Yes/ No
15
Any electricity dues outstanding for the premises for which connection applied
for:
Yes/ No
16
Any electricity dues outstanding with the licensee against any firm with which
the
consumer
is associated with any firm as an Owner, Partner, Director or Managing
Director:
Yes/ No
(For
serial 15, 16 & 17 if answer is ‘Yes’ in any case please provide details)
17
I/ We hereby declare that
(a)
The information provided in the form above is true to my knowledge.
(b)
I/ We have read the Madhya Pradesh Electricity Supply Code 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.
Signature
of the consumer/ authorised signatory
Date:
________________
Place:
________________
Note:
The following
documents shall be attached with the application form
1.
Proof of ownership of the premises
2.
A map indicating therein the proposed location of the plant/ office and
the point
where
supply is required. The map should normally be of the scale of 1 cm
representing
1200 cm.
3.
Licence/ 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 statute.
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 authorised 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.