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Power Supply Application Form A-I (Industrial)

New Connection
Additional Load

. _______________________________ (
/ :)
Consumer No.

( (1)
.)

(Neighbours for New Connection / Self for Additional Load )

(In case of Additional Load only Tables A (1) & B are required to be filled)

(
)
-2005

Subject to the provisions of MERC Electricity Supply Code

& other Conditions of Supply & SOP Regulation, 2005.

/ / /.
I/We hereby submit this application for New connection/ Additional load for supply of electrical energy at the premises mentioned below.

: -

. Note: Please tick

A.

.) 

1)

* ( ) (
)

appropriate box and strike off which is not applicable.

Details of Applicant and Premises{*- Mandatory Fields }

First name
/ Name of Father/Husband
Surname

Applicants Name (IN BLOCK LETTERS)

(As per the proof of Identity)
OR/AND

1)

* / ( ) Firm /

2)

(
-


) * Address of
premises at which supply is required (Please furnish complete details - Minimum as per the Address proof)
.
.

Companys Name (IN BLOCK LETTERS)

Survey No.:
/ /

Lane / Street/ Landmark :

3)
4)

District :

.:

Email Id:

Phone No:

*
Type of premises

B . .
LT

.:
Mobile No:

/ ( )

Self Owned

Rented

Occupier / Other (Pl. Specify)

Power Supply Requirement

Single Phase

Three Phase

Existing sanctioned Load

/ Demand
C.

Plot No.:

:
Taluka :
Pin Code :

KW
KVA

HT

KW
KVA

New / Additional
demand

Total Load/ Demand

KW
KVA

. Declaration :

/ ;
2003
(

) 2005 / .





/ /

. /
.

,
/.

/ .

/ .

I/we make the following declaration; that I/we shall

Abide by the provisions of the Electricity Act 2003 and Maharashtra
Electricity Regulatory Commission (Electricity Supply Code and other
conditions of Supply) Regulation 2005.
Pay all electricity arrears (if any) of the premises for which I am / we are
availing the electric supply.
Pay for the consumed electricity based on the prevailing tariff rates of
MSEDCL.
Pay for all other charges as they become due in accordance with above
regulation and approved schedule of charges of MSEDCL.
Deposit such security as MSEDCL may be entitled to recover from me/us
under the above Act and Regulations.

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. ,
.
,


.
/


/
/ .
/ __________________________________________________
/
:
/.

Undertake to avail supply within one month from the date the MSEDCL
intimates that it is ready to supply to our premises failing which I/we
undertake to pay the MSEDCL the fixed charges as may be applicable.
Have obtained all required statutory permissions for availing an electrical
supply. I promise to fulfill all the statutory requirements from time to
time. I also undertake that MSEDCL will not be responsible for any
issues arising due to non compliance (if any)] of adhering to these
statutory permissions.
In the event of death of individual I/We hereby nominate to receive or
adjust the deposit outstanding in my/ our name to
Shri/Smt/______________________________________________
The above information is true and if any false information is observed, I
/we will be fully responsible for the same.

.
All submitted documents are verified by me.

(......, , )

( Name, Designation & Sign of Representative of MSEDCL)

Signature of Applicant & Date

D. . Important Note:
1956 45
,



- / , , , ,

,
,

.
Under Rule 45 of the Indian Electricity Rules, 1956, No electrical Installation work including additions alterations repair and adjustment to an existing installation
except such replacement of lamps, fans, fuses, switches, low voltage domestic appliances and fittings in no way alter its capacity or character shall be carried out
upon the premises of or on behalf of any consumer owner or occupier except by an electrical contractor licensed in this behalf by the State Government and under
the direct supervision of person holding a certificate of Competency and by a person holding a permit issued or recognized by the State Government

E. .

(
)

Documents Attached (Please Tick )

a. .
Address Proof

b. .

Other documents required

-

( )
Owners NOC (If the applicant is

( )

NOC from MPCB (if applicable)

tenant)/ Three month house rent receipts.

(
)


(Any one of the following documents)

Authorization letter for signature on

documents (in case of Company or
partnership).

Local Authority

Certificate of

c..
. Documents
required before release of Electrical Connection
1. (For LT consumers)
Report (D-1 Form)

/
/
Developer Agreement with Land
Owner/ Occupier/ Govt. Agency

7/12
Govt. Issued Property Card or 7/12 Extract

Any document for proving owner or
occupier of premises.

1)

/ ,

.
List of Directors/Partners alongwith their
contact address, email & mobile numbers.

Capacitor Test Certificate

(For HT consumers

Only)

/ .

List of

Machinery with HP / KW

KVA MD Calculation

Sheet.

( -1) Installation Test

Report (D-1 Form)

Incorporation from Registrar of Company

Purchase / Sale Agreement

2.

Tax / Receipt

( -1) Installation Test

Permission from Electrical

Inspector

Test Certificate
- ,

Manufacturers

Transformer, etc.

. 200/-
(-2 )
If any of the above document is not
available then affidavit on Rs.200/- stamp
paper should be submitted. ( format -2
enclosed)

 (Note) : ( )
5 ( )

(This form is to be
submitted along with all the required documents in triplicate (one original & two copies) for LT connections and in 5 sets (1 original & 4 copies for HT)

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