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NS Application Form For HT Connection 28022018

This document is an application form for obtaining a high tension electricity service connection from the Assam Power Distribution Company Limited. It requires the applicant to provide personal information, details about the premises, and the purpose of electricity usage, along with necessary documentation. The form also includes a disclaimer regarding the accuracy of the information provided and outlines the responsibilities of the applicant.

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rskonsammangang
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72 views1 page

NS Application Form For HT Connection 28022018

This document is an application form for obtaining a high tension electricity service connection from the Assam Power Distribution Company Limited. It requires the applicant to provide personal information, details about the premises, and the purpose of electricity usage, along with necessary documentation. The form also includes a disclaimer regarding the accuracy of the information provided and outlines the responsibilities of the applicant.

Uploaded by

rskonsammangang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ASSAM POWER DISTRIBUTION COMPANY LIMITED

Affix recent
th
Registered Office: 4 Floor, Bijulee Bhawan, Paltan Bazar, Guwahati - 781001 Passport size
Photograph of
Website: www.apdcl.gov.in
applicant /
Application Form for High Tension Service connection (New/Premises authorized
Shifting/Contract Demand Change/Name Change) signatory
(Please tick whichever is applicable)

For Office Contract A/C No. Date of Connection:


Use

To,
…………………………………………
…………………………………………
…………………………………………

Sir / Madam,
I / We, request you to supply electricity to my / our premises. The requisite information is furnished below:

Name of applicant (in BLOCK


letters)
1
Individual / Govt. Deptt. / Other Organization
Type of Applicant (tick whichever is applicable)

Address of the Premises where service connection is applied for:

House No.: Lane:

Road: Area:

2
Town: PO:

District: Pin:

Mobile No (mandatory):
Email Id (mandatory):
Alternate mobile number (if any):

Total Connected Load (KW): Category of tariff: CD Required (KVA):

Supply Voltage required (KV): 11 KV / 33 KV / 132 KV / 220 KV


(tick whichever is applicable)
Duration (if temporary):
3
Purpose for which Electricity is required (please specify):

Category of tariff opted for:

Whether the Applicant is the owner of the premises (tick whichever is applicable) Yes / No
(In case the applicant is not sole owner, NOC from owner / partner has to be submitted).
4
Any Electricity dues outstanding for the premises for which connection applied for: Yes / No
(If Yes, details to be furnished.) (tick whichever is applicable)

Disclaimer: I / We declare that the information given above is true to the best of my knowledge and belief. I further confirm that there are no orders of Court / Govt. restricting electricity
connection in the premises. I / We hereby request for an inspection, of my / our premises, address of which is given above, by your authorised representative, and preparation of an estimate,
giving in requisite details of the expenditures to be borne by me / us in terms of the regulations made under Electricity Act, 2003 for the purpose of getting connection for supply of electricity
at my/ our premises. I / We also assure full co-operation to the Licensee for any delay caused due to act of God, strikes, curfew and other special circumstances during the entire process. In
case of any wrong information furnished by me / us intentionally or unintentionally, APDCL will be at liberty not to release service connection and forfeit the money if deposited or disconnect
the line. I/we will own the responsibility of security and safety of the meter, metering installations, cut-out and the installations thereafter.

Date: Signature of the applicant / authorized signatory:


Place: Name in full:
Documents to be submitted:

1) Proof of Identity (PAN/Passport/Voter ID/Adhaar /Bank Passbook).


2) Proof of Address submitted (Passport/Voter ID/Adhaar /Bank Passbook).
3) In case of proprietary firm, an affidavit stating that the applicant is sole proprietor of the firm.
4) NOC (In case the applicant is not the owner of the premises).
5) In case of Partnership firm, partnership deed.
6) In case of Limited Company, Memorandum and Articles of Association and Certificate of Incorporation.
7) Self-attested copy of Land Document (Myadi / Govt. Land).
8) Copy of Building Permission.
9) Right of Way declaration from applicant.
10) Transformer Quotation.
11) The charging permission from the Chief Electrical Inspectorate after erection of the Substation.
12) Full phase-wise load details of the apparatus along with Test Certificate from Licensed Contractor with valid License No.

Received By Signature of FME Signature of SDE

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