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New Service Application - Terms and Conditions

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200040530225103
FORM-I
Application Form for L.T.Service Connection (except Temporary Supply,agriculture and Hut)
FORM OF REQUISITION FOR SUPPLY OF LOW TENSION ENERGY(SINGLE PHASE/THREE PHASE)
[Refer regulation 27(3)]

TO
The Designated Engineer
AE/O&M/ North / perundurai

9445852049

(Address of the licensee)

Sir,
1.I/We Thiru/Tmty THANGAMUTHU P, hereby request you to supply electrical energy for the purpose of to the premises hereinafter
described.

2.I/We agree to pay for said energy, service connection charges, the deposit of such security, meter rent,development charges and an
other charges as may be demanded in accordance with the scale of rates prescribed under Tamil Nadu Electricity Distribution Cod
Supply Code, notifications and orders issued in this regard by Tamil Nadu Electricity Regulatory Commission.

3.I/We wish to be charged under tariff under schedule of the TNERC tariff order in force.

4.I/We agree to avail supply and utilize the energy in the premises described hereunder for my/our bonafide use.

5.In case,I/We sell or otherwise dispose of the property / vacate the premises while the supply is continued, I/We agree to give on
Calendar month notice in writing and pay all the arrears to the Licensee. Failing such notice, I/We hold myself/ourselves liable f
payment of arrears of current consumption charges,other dues if any and claims that may arise in the event of termination
agreement and undertake for loading the dues to other service connection(s) that may stand in my/our name(s).

6. Description of the premises

d)Owned by (Name in Block Letters):THANGAMUTHU P
e) Tenanted by (Name in Block Letters):Not applicable

f)Applicant(s) address for correspondence: 555/4,5,6,11,12,VELLIAM PALAYAM,KARUMANDISELLIPALAYAM,Perundurai

g)Contact no and e-mail id: 9080626677,mohanrajpoongodi@gmail.com

Sl.No Description Number of Points Wattage of Points Total wattage

A) Lighting points

1. Lights 0 0 0

2. Fans 0 0 0

3. Convenient wall plugs 0 0 0

B) Domestic Electrical Apparatus

1. Cookers 0 0 0

2. Water heaters 0 0 0

3. Refrigerator 0 0 0
 4. Air conditioner 0 0 0

5. Lifts/Elevator/Escalators 0 0 0

6. Other Purposes 0 0 0

7. Convenient wall plugs 0 0 0

C) Power Loads

1. Domestic 0 0 0

2. Industrial 0 0 0

3. Welding 0 0 0

4. Other purposes 0 0 0

5. Convenient Wall plugs 0 0 0

8.Demand applied for in KW: 4 KW

9.Whether the installation is provided with earth protective device (RCD)as per TamilNadu Electricity Distribtion Code:

10.The wiring has been completed on: null

11.Details of existing service connection(s) of the applicant(s) if any:

12.Whether any current consumption charges or any other charges are due to TANGEDCO in the name(s) of the applicant(s) or
premises:

PRECAUTION TO BE ADOPTED BY CONSUMERS,OWNERS,OCCUPIERS,ELECTRICAL CONTRACTORS,ELECTRICAL WORKMEN AND

SUPPLIERS

No electrical installation work,including additions,alterations,repairs and adjustments to existing installations,except such replacement
lamps,fans,fuses,switches,domestic appliances of voltage not exceeding 250 V and fittings as in no way alters its capacity or characte
shall be carried out upon the premises of or on behalf of any consumer ,supplier,owner or occupier for the purpose of supply to suc
consumer,supplier,owner or occupier except by an electrical contractor licensed in this behalf by the State Government and under the dire
supervision of a person holding a certificate of competency and by a person holding a permit issued or recognized by the Sta
Government.

I/We certify that we are aware of the above precaution and agree to abide by it .

I/We agree to pay to the licensee at the applicable tariff/minimum rates/fixed charges/surcharges etc.,that may be decided by the th
Commission from time to time .

I/We agree to abide under all specifications,conditions and provisions laid down in TamilNadu Electricity Regulatory Supp
code,Distribution Code and the applicable Act,Codes,Rules and Regulations and of any modification or re-enactment thereof for the tim
being in force and subject to the conditions of revisions, amendments approved from time to time.
(Note:This undertaking does not preclude execution of a seperate written contract to be entered with Licensee).

Signature of the Applicant(s)

Name(s) in Block letters

Place:-638052
Date: 04-02-2025

Note:The application shall be accompanied with the following documents:

(i)The self attested copy of proof of ownership such as sale deed (or) partition deed (or) gift settlement (or)allotment letter (or)comput
patta (or)ownership certificate issued by revenue department officials (or)court judgement or recent property tax receipt.
(ii) In case of joint property ,self attested copies of proof of ownership along with parent documents specified in note (i) above and conse
letters from co-owners.If consent letter is not produced,an indemnity bond with enhanced security deposits.
(iii) If the applicant is not the owner,consent letter from owner in FORM No.5 or valid proof of occupancy and indemnity bond in FORM No.6

(FOR LICENSEE'S USE ONLY)

ACKNOWLEDGEMENT

Applicant's Name:THANGAMUTHU P
Address:555/4,5,6,11,12,VELLIAM PALAYAM,KARUMANDISELLIPALAYAM,Perundurai
Date of receipt: 04-02-2025
Reference No.:200040530225103
Category of Supply:

AE/O&M/ North / perundura

9445852049

Signature and seal of Distribution Licensee

Name and Designation
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