NORTHERN POWER DISTRIBUTION COMPANY OF TELANAGANA LIMITED
WARANGAL, TELANAGANA
Appendix – I
APPLICATION FOR SUPPLY OF ELECTRICITY AT LOW TENSION
Photo of the
Customer
To,
The Asst. Engineer / Operation
I/ We request you to supply electricity at Low Tension to my/own Premises as mentioned below:
1. (a) Name of the applicant in whose name connection is required
First Name Middle Name Surname
(b) Father’s name:
2. (a) Location of Premises where supply is required
House Number: Mandal:
Street: Village:
District: Pin Code:
(b) Nearest electric pole number
(c) Type of Service Wiring
1. Over Head Under ground
2. Type of entry: Enclosed in PVC Conduit: Yes No
G.I. Pipe: Yes No
3. Is the pipe externally visible: Yes No
(d). Is wiring in the Premises completed: Yes No
The details are as follows (If yes):
Name of the Licensed Electrical
Contractor
License Number
Full Address
(e). Are any other services existing in the same Premises: Yes No
If yes, please give Service Connection Numbers of those Services
Service Connection Number Category
(f). If any other services are existing elsewhere in the same name or in the
names of sister concern: Yes No
If yes, please give the details of those services
Service Connection Number Category Location
3. Address and Telephone Number for communication.
Address Telephone Number e-mail address (If any)
4. Type of Service required (Please tick the Service applicable)
New Connection/[Link]
Title Transfer:
Present Consumer’s Name: _______________________________________
New Consumer’s Name: _______________________________________
Service Connection No: _____________________
Change of Category:
Existing Category: ________________
Proposed Category: ________________
Effective date: ________________
5. Connected Load Requested: kW HP
6. Details of Proposed Connected Load
For Domestic / Commercial For Industries / Agriculture Services/
Establishments Street Lights/ General
Purpose/Temporary Supply
Details of Nos. * Total Details of Nos. * Total
Appliances Wattage of Wattage Appliances HP/kVA Load
each Motors
Lights Welding sets
Fans Heaters
Electric furnaces
Battery chargers
Fridge Lights & Fans
Mixer Total Load
Grinder Existing Load
Washing Addl. Load
Machine Total Load
Electric Iron
A.C.
Geyser
Water Pump
Cooking Range
Plugs
Others
Total Load
Existing Load
Addl. Load
Total Load
[Link] of Applicant (Please tick the service applicable):
Individual Registered Partnership
Unregistered Partnership Public Limited Company
Private Limited Company Any Other
[Link] Group:
SC ST Others
9. Category of supply (Please tick the Category Applied for):
Category Type Category Type
LT-I Domestic LT-I Agriculture
LT-II Non-Domestic & Commercial LT-II Street Lighting
LT-III Industry LT-III General Purpose
LT-IV Cottage Industry LT-IV Temporary Supply
10. Details of Application fee paid:
Demand Draft for Rs. Bank drawn on Demand Draft Date
11. Supporting documents enclosed (Please tick where applicable):
Category Supporting Documents to be Furnished
Common to all
Completed & signed Application Form along with the
LT categories
Signed Declaration
except
Proof of ownership (Sale deed, Allotment/possession
Commercial &
letters lease deed, Municipal tax payment receipt) or
Industrial
Proof of occupancy (Lease/ Rental deed with landlord,
Electoral identity card or Passport or PAN card along with
proof of ownership of landlord)
Indemnity Bond (Letter of consent from landlord to tenant/
lessee/ occupier)
Wiring Completion Report (from a licensed electrical
contractor)
Test Report
Demand Draft for new connection charges
Commercial In addition to the above
Valid municipal license for running commercial establishment
Industrial In addition to the above
Valid industrial license
Additional Documents to be provided
Necessary community certificate enclosed
SC or ST
Location, Head office, names & address of Partners & copy of
Partnership Partnership deed enclosed.
Name of Present Directors & Copy of Memorandum of Articles
Company of Association enclosed
Indemnity bond and Declaration
12. Undertaking:
i. I/ We undertake and agree to pay the Tariff and Miscellaneous charges
prescribed by the Company and to abide by the General Terms and
Conditions of Supply notified by the Company from time to time, which shall
govern the supply of electricity to me/ us in all respects.
ii. I/ We shall undertake to execute an Agreement in the prescribed form, if so
called upon by the Company. Whether such an Agreement is executed or not,
this application itself shall oblige me/ us to conformed abide by the General
Terms and Conditions of Supply notified by the Company from time to time.
iii. I/ We certify that I have no dues to the Company either here or anywhere.
iv. I/ We certify that there is no case of Theft of Electricity / Unauthorized Use
of Electricity, pending against me.
v. I/ We undertake and agree for recovery from the excess paid amounts, if any
against services found to be under disconnection or services with or
Unauthorised use of Electricity cases or Theft of Electricity cases found, and
also Against services clubbed for being in the same premises.
vi. I/we undertake to provide suitable arrangements for ‘way leave’ at
my/our own cost.
vii. I/We request the company to provide meter for measuring the electricity
supplied to me / us. I / We will pay the monthly meter rentals, as may be
fixed by the Commission from time to time.
Signature of Applicant Signature of Original Owner
(in case of title transfer)
Place Date
Signed by the applicant in my presence:
Witness 1 Witness 2
Signature: Signature:
Name and Address: Name and Address:
Date: Date:
(For office purposes only)
RECORD OF THE APPLICATION
1 Sent to AE/Operation on ______________________
2 Work allocated to _______________________
a) Separate Portion Yes/No
b) No OSL/UDC/TE/UUE/BB Premises Yes/No
c) Connected load is same as declared Yes/No
d) Whether Service wire is concealed Yes/No
e) HT & LT Clearances maintained Yes/No
f) Whether any Overhead lines are passing over the house/ Premises Yes/No
g) T/F code /Feeder Code
h) T.C Seal No: No: P.P Box Seal No
with Impression:
3 Received from the Designated Officer along with Test Report on_______________
4 SC No______________________ Signature of -----------------------------
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ACKNOWLEDGEMENT OF APLLICATION AND INTIMATION OF PAYMENT
DETAILS
Designated Office Date of Submission of
Application / Registration
Registration No. Signature of the Receiving
Officer with Stamp
Total Payment
Received
Signature of ---------------------------------------
