To

The _____________________

________________________

Sir,

1. I/we request you to supply electricity at L. T. /H. T. to my/our premises situated at_______________. The requisite information is furnished below:

   1. Name of the consumer:
   2. Address for communication:
   3. Status of consumer: Consumer should state his legal status(i. e. ,) whether he is individual, partnership firm or limited company or any other legal person. In case of partnership firm, it should be stated whether it is registered or unregistered, location of its Head Office, names and addresses of all partners and a copy of partnership deed should be filed. In case of Company, it should be stated whether it is private limited or public limited, names of present directors and a copy of memorandum of articles of association should be furnished. In case of any other type of legal person full details and name and address of person competent to represent the consumer should be stated).
   4. Location of premises where supply is required.
   5. Category of supply:
   6. Contracted load:
   7. Contracted Demand in HP/KVA
   8. Details of connected load at the time of commencement of supply.
2. I/we undertake to agree to pay at the tariffs and Miscellaneous and general charges prescribed by the Board and abide by the terms and conditions of supply notified by the Board from time to time, which shall govern the supply of electricity to me/us in all respects.
3. I/we request that the Board should provide necessary meter/meters/metering equipment.
4. I/we shall undertake to execute an agreement in the prescribed form, if so called upon by the Board. Whether such an agreement is executed or not, this application itself shall oblige me/us to conform to and abide by the terms and conditions of supply notified by the Board from time to time.

Station:___________________



´

(Signature of the Consumer)

Dated:_______________

Witness: