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NEW CONNECTION

                          NAME OF THE APPLICANT/ FIRM:…………………………………….

                          POWER SUPPLY REQUIRED AT (ADDRESS)

……………………………………………………………………

……………………………………………………………………

……………………………………………………………………

SERIAL NO:………………………………………………………

ISSUED TO SRI / M/s……………………………………………..

ISSUED ON……………………………………………………….

REGN FEE PAID Rs………………………..  Rt. No………......   DATED.……….. 

Office stamp.                                                  Assistant Engineer, Elecl.,

                                                                            Technical section.

THIS APPLICATION IS NOT TRANSFERABLE

TO:

1. The Executive Engineer, Elecl.,
2. ……………………O & M Division,
3. The Asst. Executive Engineer, Elecl.,
4. ……………………O & M Sub Division,
5. Karnataka Power Transmission Corporation Limited,
6. …………………………………………..

Dear Sir,

I/ We hereby request you in accordance with the clause VI of the schedule of the Indian Electricity Act 1910, within one month or within such longer period as the Electrical Inspector may allow from the date of this requisition to supply energy to the premises owned / occupied by me / us and situated within the area of supply.

I / We further request you to supply me/ us the meter necessary in terms of section 26 of the Indian Electricity Act 1910. I/ We agree to give you such security as may be required for the meter/ meters whenever called upon to do so. I/ We have also gone through the instruction’s obtained in this form and I /We have attended all the necessary documents along with this application.

1. Name of the applicant / company………………………………………….
2. Name of the authorized signatory………………………………………
3. Father’s name :…………………………(In case of ownership company.)
4. Age of the applicant:………………………….years
5. Occupation/Designation ………………………………………………
6. Power supply required at…………………………………………(address) ………………………………………….

7. Type of Ownership: The premises is Owned/ Leased/ Singly owned/ Partnership/ Private company/ Public company.(documentary proof to be produced, and if partnership MOU to be enclosed)

8. If licence from appropriate authority obtained: Y E S / NO.(LICENCE not required in industrial area of KIADB/ KSSIDC)
9. Premises located in : industrial area of KIADB/ KSSIDC/ Private layout/ Municipal/ corporation/ Village panchayat area.
10. Is the connection new/ additional to old installation:………………………….
11. Details of the power required : Single Phase ………… HP + ……… KWs Three phase …………. HP + ………...KWs.
12. Total electrical power required:………………………..HP + ……………….KW.
13. Sister concerns, if any:…………………………………………………………..
14. Address for correspondences ………………………………………till the power supply ………………………………………….is arranged:…………………………            Telephone No. ………………………. STD code.………….
15. Details of enclosures:

1. Site plan with proposed location of the meter Board.
2. Latest Tax paid receipt.
3. License/permit/NOC from local Body.
4. Route map to locate the Premises.
5. If lessee, registered lease agreement.
6. Environmental clearance certificate wherever applicable

Certified that I/ We have gone through the instructions given to the applicant in this brochure and have filled up all the columns.

Certified that the above information furnished by Me/ Us are true and correct.

I/ We/ are also aware that I/We are solely responsible for the incorrectness if any in the above declaration. If any of the information furnished above is false, KPTCL may disconnect power supply without notice.

I/ We / are agreeable to execute the works as estimated on self execution basis.

Dated on ………………………….

Place…………………………                Signature of the applicant/authorized signatory

(Stamp of the firm)

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