ltconnapp

8/12/2019 LTConnApp

http://slidepdf.com/reader/full/ltconnapp 1/7

-----------------ASSAM POWER DISTRIBUTION COMPANY LTD.

Annexure 1: Applic!i"n n# A$ree%en! &"r% 'L"( Ten)i"n Ser*ice C"nnec!i"n

+Re&er !" clu)e ,..1

(Please strike-off the purpose that is not applicable)

To,

The Sub-Divisional Engineer

……………………Electrical SubDivision.

………………………………………………………………

_____________________________

e!uisition for " (a) #e$ connection

(b) Te%porar& connection 'ro%

(c) Eisting onnection (i) Etension of loa*+contract De%an*

(ii) e*uction of loa*+ontract *e%an*

(iii) Shifting

(iv) hange in na%e+

(v) hange in categor& of consu%er

(vi) thers (to specif&)

onsu%er #o. (for eisting consu%ers onl&)

8/12/2019 LTConnApp


Sir,

+ e re!uest &ou to suppl& electricit& to %& + our pre%ises (ne$ + te%porar& + eisting connection

for change as %entione* above). The re!uisite infor%ation is furnishe* belo$"

/. #a%e of the 0pplicant(s)

(n block letters)

1. n*ivi*ual + 2ovt Deptt. +ther organisation(specif&)

3. (a) #a%e of father + husban* (in case of in*ivi*ual)

(b) #a%e of Depart%ent + rganisation

($ith Designation of 0pplicant if applicable)

4. (a) Per%anent a**ress

5ouse #o. + Plot #o. "

oa* "

6ane "

0rea + olon& "

To$n+7illage "

Post ffice "_______________________________________________________

District "

P# "

Telephone #o " (if an&)

E-%ail (if an&) ________________________________________________

4 (b) 0**ress of the pre%ises $here a ne$ connection is hereb& applie* for+ the eisting

connection is propose* to be shifte*"


8/12/2019 LTConnApp


oa* "

6ane "

0rea + olon& "

To$n+7illage "

Post office "______________________________________________________

District "

P# "


E-%ail " (if an&)

4. (c) 'ull a**ress for correspon*ence an* sen*ing bills (if *ifferent fro% 4(a) or 4(b)


oa* "

6ane "

0rea + olon& "

To$n+7illage "

Post ffice "_______________________________________________________

District "

P# "


E-%ail (if an&) ________________________________________________

4. (*) P0# #o. (if an&) ___________________________________________________

8. (a) 9uilt-up area of the pre%ises_______________________ s! %etre

(b) 5eight of the 9uil*ing "

:. Purpose +ategor& of suppl& "

8/12/2019 LTConnApp


;. Propose* onnecte* 6oa* "

(a) 'or *o%estic, co%%ercial an* general purpose Suppl& " ___________________atts

(Please fill-up an* attach for%at 0ppen*i 1 - for *eter%ination of connecte* loa*.)

(b) 'or other categories please fill up the follo$ing (0ttach *ul& signe* separate list if

re!uire*)

I!e%L"# per i!e%

+/(N".

T"!l l"#

+/(

<. Distance fro% the nearest *istribution %ains to the epecte* point of connection "

(The above infor%ation provi*e* b& the consu%er $ill onl& be treate* as in*icative. During

feasibilit& stu*& the 6icensee $ill *eter%ine the point of *istribution %ains an* the route

through $hich the cable+ service connection $ill be *ra$n)

=. 0n& electricit& *ues outstan*ing in 6icensee>s area of operation in consu%er>s na%e " ?es+ #o

=0. Details of an& other electricit& connection in the licencee>s area in the na%e of the consu%er ,if

an&.

/@. 0n& electricit& *ues outstan*ing for the pre%ises for $hich connection applie* for " ?es+ #o

('or serials =,=0 A /@ if the ans$er is B?es> in an& case please provi*e *etails)

//. + e hereb& *eclare that the infor%ation provi*e* in this application is true to %& kno$le*ge.

+ e have rea* the 0ssa% Electricit& Suppl& o*e an* onnecte* Catters egulations an* agree to abi*e

b& the con*itions %entione* therein.

+ e agree to *eposit an a%ount as securit& *eposit for loa* an* also for %eter (if applicable) before

the connection is provi*e* to %e an* also a**itional a%ounts fro% ti%e to ti%e as, %a& be *ue

fro% %e, against *e%an* raise* b& the license, $ithin specifie* ti%e.

+ e shall *eposit electricit& *ues, ever& %onth, as per the applicable electricit& tariff an* othercharges.

8/12/2019 LTConnApp


+ e shall o$e the responsibilit& of securit& an* safet& of the %eter, cut-out an* other suppliers

$ithin %& +our pre%ises the installation.

Date " Signature of the consu%er +

0uthorie* signature

Place " #a%e "

Designation (if an&) "

rganisation "

N"!e : The follo$ing *ocu%ents shall be attache* $ith the application "

(a) Proof of legal occupation of the pre%ises along-$ith the cop& %ap of the pre%ises+ lan*,

in*icating propose* point of suppl&, *ul& approve* b& the local authorit&. n case of

streetlights the location of street light poles shall be in*icate* in the %ap.

(b) 0pproval + per%ission of the local authorit&, if re!uire* un*er an& la$ + statute.

(c) n case of a partnership fir%, partnership *ee*.

(*) n case of a 6i%ite* 6icensee, Ce%oran*u% an* articles of 0ssociation an* ertificate

of incorporation.

(e) Proof of per%anent resi*ential a**ress of the applicant.

(f) Electrical ontractor>s Test eport (n appen*i 3)

N"!e : The ontractor>s Test report %a& not be sub%itte* $ith the 0pplication but the supplier %a&re!uire at least ; *a&s ti%e for provi*ing the connection after receipt of the Test eport.

---------------------------------------------------------------------------------------

8/12/2019 LTConnApp


A$ree%en! Pr!

( #ot to be fille* up b& consu%er $hile sub%itting the application)

/. #a%e of consu%er

1. 7oltage of suppl&

3. Single or three phase

4. ategor& of suppl& an* tariff

8. onnecte* loa*

:. ontract *e%an*

;. $nership of %eter

<. Point of co%%ence%ent of suppl&

=. Etension +Service connection $ork $ill be *one b& licensee+consu%er(Delete $hich is not applicable

/@. 0n& other %atter

n $itness there of __________________________________ (#a%e an* *esignation of6icensees authorise* Eecutive) acting for an* behalf of the Distribution 6icensee an*

__________________________________________________ (consu%er) have hereunto set their

han*s an* seal on this ____________ *a& of the %onth of ____________________ of the &ear

____________________.

n behalf of licensee onsu%er

#a%e an* a**ress

Signature

Seal

Place

itness itness

/

1

/

1

8/12/2019 LTConnApp


ltconnapp

Documents