The power of service

Customer No. (For Office Use)

16.1 APPLICATION FOR SUPPLY / ADDITIONAL LOAD / SHIFTING / EXTENTION OF SERVICE

/ CHANGE OF NAME / CHANGEOVER OF SUPPLY

Under Section 43 of Electricity Act 2003 hereinafter called ‘Act’ and MERC (Electricity supply and other Conditions
of supply) Regulation 2005, here in after ‘Regulations’.

Note Intending consumers are requested to see that this form is fully, clearly and legally filled and signed with date
before sending to the company. Please tick the box, whichever is applicable. (Please provide complete details)

I/We hereby submit application for Affix passport size

photograph and sign across
New Connection Additional Load Reduction of Load

Change in Contract Demand Change of Name Shifting

Changeover of Supply Change of Tariff Category

To the premises owned/occupied by me/us and situated within the area of specified in the Note: Please do not staple the photograph
Adani Electricity License, 2011
First Name Middle Name Surname

1 Applicant’s Name Mr/Mrs/Miss/M/s

(in block letters)

Occupation/Designation

Address at which supply is required

Flat No./Building Name

Lane/Street

Landmark

Suburb/City Pin Code

Area of Premise Sq mtr Email

Phone No. Mob No.

Preferred Bill Language is Marathi Hindi Gujarati English

Bank Account Number

Bank Name/Branch

Existing/Nearest Consumer Account number Meter No.

Type of Premises
Owned Rented Lease Others (Specify)

Category of Premises
Chawl Hut Bunglows Multi storied Building Others (Specify)

Incase of Premises on Rent or Lease not owned by Applicant

Name of Owner

Flat No./Building Name

Lane/Street

Landmark

Suburb/city Pin Code

2 The following are my requirements (Please tick appropriate box) (To be filled by LEC)

Residential BPL Charitable/Religious Non Commercial/Educational Others (Specify)

Commercial Office Construction/Power Others (Specify)

Industrial (Type of Industry) Others (Specify)

2.2 The connection will be

New Service Tapping
1
2.3 Details of the Apparatus NO. OF POINTS WATTAGE OF EACH VOLTAGE TOTAL WATTAGE

a) Bulbs

b) CFLs

c) Tubelights

d) Fans

e) Geysers

f) Ovens/Microwave

g) Air Conditioners

h) Refrigerators

i) Television

j) Plug-5/15/30 Amp

Total no. of Points Total Wattage Contract Demand

Total No. kw kva

(Incase of any other apparatus attach
a separate sheet with specific Wattage)
3 The wiring carried out/certified by the following Licensed Electrical Contractor

Name
Address
Telephone number
Email Rubber Stamp

Licence No Valid up to d d m m y y y y

4 Applicant’s Present/Correspondence Address

Flat No./Building Name

Lane/Street

Landmark

Suburb/City Pin Code

5 For Changeover of Supply

5.1 Meter Number CA number

5.2 The meter would be provided by

Existing Distribution Licensee New Distribution Licensee Self

6 Change of tarrif category From To

IMPORTANT NOTICE

Under Rule 45 of the Indian Electricity Rule 1956, no electrical installation work Indicative list of the document/NOC/Clearance
including additions, alterations, repairs and adjustments to existing installation, Attached
except such replacement of lamps, fans, fuses, switches, low voltage domestic
appliances and fittings as in no way alters its capacity or character, shall be carried I have read and agreed to the notice above and make the
out upon the premises of or on behalf of any consumer or owner, for the purpose of
following declaration
supply to such consumer or owner, except by an electrical contractor licensed in
a) To abide by the provisions of the Electricity Act 2003
this behalf by the State Government under the direct supervision of a person holding
a certificate of competency issued or recognised by the State Government.
and Maharashtra Regulatory Commission
(Electricity Supply Code and other conditions of supply)
Where any electrical installation work of the nature specified above has been carried
b) To pay for the supply of electricity based on the
out otherwise than under the direct supervision of a person holding a certicate
prevailing tarrif rates of Adani Electricity
issued by the State Government and by the electrical contractor licensed by the
State Government in this behalf, the consumer owner or occupier, the contractor
c) To pay all the charges which are due, in accordance with
(if any) or the person through whom the work is being or was carried out and the the above Regulations and approved schedule of
person under whose immediate supervision the work is being or was carried out, shall charges of the Company
each be punishable with fine which may extend to Rs. 300/- under the Rule 139 of d) To pay the security deposit as per the provisions of
the Indian Electricity Rule 1956. above Act and Regulations

d d m m y y y y
Applicant’s Signature Date
FOR OFFICE USE

Business Partner Number

Contract A/c Number

2
 TERMS AND CONDITIONS

Please note that no consumer/applicant who have licensee and existing distribution licensee for the
defaulted in payment of electricity bills and other preparation of last due bill and the same meter reading
charges shall be allowed for a change over without shall be opening meter reading for new distribution
clearing dues of the existing distribution licensee. licensee and such meter reading statements shall be
signed by all, i.e. existing distribution licensee, new
The consumer/applicant shall submit the proof of its distribution licensee and the consumer/applicant. In
payments of last bill as served by the existing case the consumer/applicant is not present for the
distribution licensee and other relevant documents as reading, the readings taken jointly by existing
required under Electricity Supply Code. distribution licensee and new distribution licensee shall
be final and binding.
The consumer/applicant shall not be able to change the
name, purpose or classification of category for which the The consumer/applicant shall be liable to pay the
electricity has been provided by previous distribution outstanding bill amount as raised on final meter reading
licensee at the time of changeover. on or before due date.

The consumer/applicant shall be under an obligation to The existing distribution licensee or wheeling
provide the complete details of all the payment distribution licensee will be entitled to follow the
arrears/court proceeding or any dispute if any. provisions of law for disconnection of supply under
Section 56 of the Electricity Act, 2003 in case of any
The premised of the consumer/applicant shall be default of payment by consumer/applicant.
inspected to confirm the classification, connected load,
technical issues if any, etc and if any default is found, the Any change-over consumer/applicant who proposed to
application may be rejected for the same. change the name, purpose, category shall continue to
abide by the condition of the changeover even after
Please note that the existing distribution licensee shall change of the name/purpose/category.
have the right to adjust the security deposit of the
consumer/applicant towards the last due bill/arrears. The new/supply distribution licensee shall be entitled to
initiate appropriate procecedings for misuse of supply
The consumer/applicant shall ensure that if the sanction against the consumer and accordingly advice the
loads of the consumer/applicant are equal to or higher wheeling/existing distribution licensee to carry out
than 50 KW, the consumer/applicant shall have to enter disconnection as per the provisions of the Electricity
into a new agreement with the new distribution licensee Act, 2003.
at the time of making an application.
The existing/wheeling distribution licensee shall have
Please note that if the consumer/applicant has opted for the right to inspect the meter, and cut out seals from
new distribution licensee’s meter or opt outs for his own time to time and take meter reading for all changeover
meter, the same shall be tested by new distribution consumers.
licensee in its laboratory in the presense of existing
distribution licensee before installation of the said The existing/wheeling disribution licensee will be
meter. entitled to do the assessment as provided US/ 126 (6) of
the Electricity Act,2003 and shall provide the said
Please note that if after making an application to the information to the new/supply distribution licensee for
new distribution licensee, the meter reading for the final billing and recovery purpose and for making the payment
billing shall be taken jointly by the new distribution to existing/wheeling distribution licensee.

d d m m y y y y
Applicant’s Signature Date
FOR OFFICE USE

Business Partner Number

Contract A/c Number