A-1 Form for Power Supply for Residential / Commercial /Industrial Purpose
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(Processing fee will be waived if application and payment is madeonline)
Date of Application: ___
To,
The Engineer,
Section /Sub-Division/ Circle Office,
-------------------------------------------.
Dear Sir / Madam,
I hereby submit this application for new connection for supply of electrical energy at the premises mentioned below
A Details of Applicant
First Name Name of Father/Husband Surname
Applicants Name
1) (IN BLOCK LETTERS)
2)
Email Id: (Mobile No)
3) Aadhar Card No.(Optional)
B. Details of Premises
1)
Address of Premises
House / Flat / Gala / Survey No. Society Name:
Street / Landmark: Village:
Taluka / City & District: Pin code:
2) Type of premises Self Owned Rented Occupier/Other
3) Name & address of the Owner :(If not self owned)
4) Nearest Consumer No for reference: (Please Specify)
C. Power Supply Requirement
Type of Supply Residential / Commercial / Industrial
Single Phase (LT) Three Phase HT Connected Load (Kw)* : Contract Demand (Kva) :
(* Please refer overleaf to calculate required load.)
D. Applicants Classification (for new connection of residential only)
a) General b) SC / ST c) BPL
E. Document attached
1) Occupancy/Ownership proof:
2) Identity Proof:
3) Test report of Consumer` s premises from Govt. Authorized contractor ( to be submitted before the release of connection):
Declaration:
I hereby declare that
I will abide by the provisions of Electricity Act 2003 and Maharashtra Electricity Regulatory Commission (Electricity Supply Code and other conditions of Supply)
Regulation 2005.I will further abide by rules & regulations issued by regulatory bodies & MSEDCL from time to time.. I will pay the electricity bill as per prevailing MSEDCL Tariff.
If the premises is declared unauthorized then at the time of vacation by competent authority, MSEDCL will have liberty to remove the electric connection immediately.
The above information is true and if any false information is observed, I / we will be responsible for the consequence thereof.
Sign of Representative of MSEDCL Signature of Applicant / Thumb impression& Date
महाराष्ट्र राज्य विधुत वितरण कं पनी मर्यादित विद्युत पुरवठा जोडणी
अर्ज ए-१ ( शेतीपंप )
Power Supply Applicantion Form A-1 ( Agricultural )
नवीन वीज जोडणी अर्जदाराचा प्रकार ( Type of Applicant ) सामान्य (General )
अतिरिक्त भार # अनुसूचित जाती / जमाती ( SC /ST )
ग्राहक क्र.___________________________________ (नवीन जोडणी असल्यास नजीक च्या ग्राहकाचा /अतिरिक्त भार असल्यास स्वतःचा)
( अतिरिक्त भारासाठी अर्ज असल्यास फक्त ए ( १ ) व ब तकते भरण्यात यावे
The Engineer,
Section /Sub-Division/ Circle Office,
-------------------------------------------.
Dear Sir / Madam,
I hereby submit this application for new connection for supply of electrical energy at the premises mentioned below
A Details of Applicant
First Name Name of Father/Husband Surname
Applicants Name
1) (IN BLOCK LETTERS)
2) Email Id: (Mobile No)
3) Aadhar Card No.(Optional)
B. Details of Premises
1)
Address of Premises
House / Flat / Gala / Survey No. Society Name:
Street / Landmark: Village:
Taluka / City & District: Pin code:
Self Owned Rented Occupier/Other
2) Type of premises
3)
Name & address of the Owner :(If not self
owned)
4)
Nearest Consumer No for reference: (Please
Specify)
C. Power Supply Requirement
Type of Supply Residential / Commercial / Industrial
Single Phase (LT) Three Phase HT Connected Load (Kw)* : Contract Demand (Kva) :
(* Please refer overleaf to calculate required load.)
D. Applicants Classification (for new connection of residential only)
a) General b) SC / ST c) BPL
E. Document attached
1) Occupancy/Ownership proof:
2) Identity Proof:
3) Test report of Consumer` s premises from Govt. Authorized contractor ( to be submitted before the release of connection):
Declaration:
I hereby declare that
I will abide by the provisions of Electricity Act 2003 and Maharashtra Electricity Regulatory Commission (Electricity Supply Code and other conditions of Supply)
Regulation 2005.I will further abide by rules & regulations issued by regulatory bodies & MSEDCL from time to time.. I will pay the electricity bill as per prevailing MSEDCL Tariff.
If the premises is declared unauthorized then at the time of vacation by competent authority, MSEDCL will have liberty to remove the electric connection immediately.
The above information is true and if any false information is observed, I / we will be responsible for the consequence thereof.
Sign of Representative of MSEDCL Signature of Applicant / Thumb impression& Date
