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NAME OF THE APPLICANT :....................................................

                    ADDRESS TO WHICH POWER SUPPLY IS REQUIRED :

.............................................................................................…

................................................................................................

..........................................................................................……

FOR OFFICE USE ONLY

SERIAL NO : ................................ ISSUED TO SRI ............................................              ISSUED ON.....................

REGISTRATION FEES RS……….....PAID VIDE RPT NO. ………... DATED ..………

office stamp .                                                                  Assistant Engineer Elec.,                                                                                        Technical section .

THIS APPLICATION IS NOT TRANSFERABLE

KARNATAKA POWER TRANSMISSION CORPORATION LTD

TO :

1. The Executive Engineer , Elec
2. ....................................... O and M division
3. The Assistant Executive Engineer , Elec.,.
4. ..................................................... O and 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 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 contained in this form and I / We have attached all the necessary documents along with this application .

1. Applicant’s name :...........................................................................
2. Father’s name : ...............................................................................
3. Age of the applicant : ...................................... Years.
4. Occupation / Designation: ..................................................................
5. Address to Which the power supply ................................................is required : ....................................................…..
6. The floors existing in the building : cellar / ground / first / second / third / fourth/ fifth / sixth / seventh (PLEASE TICK THE FLOORS EXISTING)
7. Total Domestic Floor Area (Plinth Area) ………………………….sq. mtrs.
8. Total Commercial Floor Area (Plinth area)…………………sq. mtrs.
9. Is the Building new/ additional to old building:………………………………
10. Electrical load required :

FOR NEW BUILDINGS ONLY

11. 11. Additional Electrical Load required :
12.  

13. EXISTING BUILDING WITHOUT ADDED PLINTH AREA

12. 12. Additional Electrical load desired :

EXISTING BUILDING WITH ADDED PLINTH AREA

13. Total electrical load required : ........................HP + ................. KWs.

14. Address for correspondence .................................................. till the power supply .............................................................. is arranged ……................................. Telephone No.: ............................ S.T.D. Code……………............

15. Details of enclosures :

1. Sanctioned plan.
2. Architect’s plan, with location of the transformer marked.
3. Latest Tax paid receipt.
4. route map.
5. Copy of GPA (if applicable) .

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

Certified that the above information’s furnished by me are true and correct .

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

I am agreeable to pay the augmentation charges as intimated to me / execute the works as estimated on self execution basis.

Dated on ...............................                        Place : .................................... .

                                                                    Signature of the applicant/ GPA Holder

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