New Connection Form PDF
New Connection Form PDF
New Connection Form PDF
Photograph
of the Applicant
Application Date
Water Connection
Sewerage Connection
Regularization
2.Details of Applicant
Name: (Please Fill In Block Letters Only, in case of any organization write designation)
First Name :*
Middle Name:
Last Name :
Father/Husband Name*:
Govt. Organization (Please tick if it is a Govt. Organization, provide supporting document)
Name of Government Organization :
3.Contact Details
Email Id:
Mobile No:*
Office No:
4. In case of DJB Employee Office Details - Please attach copy of office Identity Card
Employee Id:
Date Of Retirement:
5.Property Address
Pin Code:*
Locality:*
Sub locality:*
House No:*
Road No:
Sub locality 1:
Sub locality 2:
Sub Colony:
Village:
Khasra No:
Society Name:
6.Property and water connection use details please refer pages - Instructions to fill the application
a. Development Charges Paid (Submit Latest Payment Receipts):
Water Receipt No.
Water
Sewerage Receipt No.
c. Urban / Rural
d. No. Of Floors:*
e. No Of Beds:*
(For Hospital Only)
g. Built Up Area:*
Locality:*
Sub locality:*
House No:*
Road No:
Sub locality 1:
Sub locality 2:
Sub Colony:
Village:
Khasra No:
Society Name:
Sewerage
Cheque
Demand Draft
Paper Format And SMS
No of Adults:*
9.Documents to be attached
a) Proof of Identity:*
Driving License
Passport
Ration Card
(any one)
PAN Card
Voter ID Card
Photo identity card issued by any govt. agency
Document No:*
b) Property Ownership Document(any one)*
Allotment letter (Private Builder) with registered sale deed / General Power of Attorney
Rented property-lease/Rent Agreement, Non Objection Certificate of Owner
DDA allotment/mutation letter/Land,Development Letter
Driving License
Passport
Document No:
10.Bank Details
Name of the Bank:*
IFSC Code:*
11.Declaration/Undertaking
a)
b)
c)
DECLARATION:
I hereby declare that all the information furnished by me is true to the best of my knowledge and if any discrepancies are found , I will be
responsible for disconnection of services by the DJB without any prior notice and any other legal action taken by DJB.
I declare that there is no dispute on property and there is no stay from any court of law against obtaining water/ sewerage connection.
I understand that sanction of connection does not acknowledge or confer any title, ownership or occupancy right in favour of the
applicant.
UNDERTAKING:
I further undertake that in case of any dispute about the ownership of the property I will absolve DJB from any legal battle in the court of
law as the water connection applied for is related to supply of potable water and not to decide the ownership of property.
ii) I further undertake to pay the charges as and when demanded by DJB, and in the event of non-payment, DJB will be at liberty to
disconnect the services being provided by DJB.
iii) I further undertake that I have not taken DJB Employee Rebate against any other Premise/Connection.
iv) I undertake to install my water connection only through license plumber of Board.
v) I Understand that the DJB has a policy not to sanction more than six individual connection for each individual plot. If more than six water
connections are required, I will surrender my existing individual water connection without any preconditions & apply for a bulk water
connection (Applicable in properties other than CGHS)
vi) I am applying for a water connection on my own and even if the water supply is available at a low pressure, I will not file any claim for
any sort of compensation in any court of Law
vii) In case of variation in plot size as per document submitted by the undersigned and on actual measurement by DJB representative,
difference of Development charges on actual measurement will be paid by me.
viii) In case connection is found non-feasible on technical ground as per any prevalent policy of DJB the water connection may be denied or
if sanctioned inadvertently, the said sanction may be withdrawn and may be disconnected without any notice.
i)
I Agree
Signature of Applicant:*
9.Documents to be attached:-
Proof of Identity : Attach photocopy of any one of the following documents and provide the document number.(Voter ID card, Ration
card, Passport, PAN card, Driving license, Unique Id Card[UID/Aadhaar Card],Bank Pass Book with applicants, Photo identity card
issued by any Government Agency).
Property Ownership Document: Attach photocopy of any one of the following documents and provide the document
number.(Registered Sale Deed, Registered perpetual lease Deed, Registered conveyance
Deed, General Power Attorney, Notarized General Power Attorney with complete backchain, Special Power Attorney with
Registered/Notarized Agreement to sell and will, Will/Non Objection Certificate of the owner in favour of applicant, Registered
Partition deed/Family Settlement Deed, Registered Relinquished Deed, Allotment Letter (Private Builder) with Registered Sale Deed,
Allotment Letter (Private Builder) with Registered/Notarized. General Power Attorney ,Allotment Letter (Private Builder),
Registered/Notarized , Agreement to sell, Rented property-lease/Rent Agreement, Non Objection Certificate, Ownership, DDA
allotment /mutation letter/Land, Development Letter, Interim court order ).
Proof of Residence: Attach photocopy of any one of the following documents (Driving license, Passport, Election ID card).
It is compulsory to provide the document number of the attached documents.
10.Bank Details
Name of the bank: Enter the name of the bank.
Name of the branch: Enter the name of the branch of the bank.
MICR code: Enter its MICR code.
Bank Account Number: Enter the applicants bank account number.
All fields listed under bank details are compulsory and must be provided correctly.
11.Declaration:
I agree:Tick the I Agree check box to accept the declaration.
Signature of the applicant: Put in the signature of the applicant in the box given.
This form captures some information (say Billing Address etc.), which may be used by DJB in future.
Reference 6b : Property Type (Enter any of the below in Property Type )
Tower
Individual House
Govt Flats
Banquet Hall
Office Complex
Hotel/Guest House
Dharmasalas/Hostels
Apartment
Hospital/Nursing Home
DDA Flats
Mall/Cineplex
Bungalows
Reference 6h: Water Connection Type (Enter any of the below in Water Connection Type)
I
Domestic
IA
Mixed Use
II
Commercial/Industrial
IIA
Property of size having 2000 sq. yards or more with Rain Water Harvesting/waste water recycling or both
Reference 6i : Water Connection Use (Enter any of the below in Water Connection Use)
B.S.E.S. RAJDHANI
B.S.E.S. YAMUNA
Juice Shop
Delhi Transco
Janta Flats
Railways
Beauty Parlors
Blind Schools
Dhobi Ghats
Restaurant
Bottling Plant
Mutton Shop
C.P.W.D.
Dry Cleaners
Sweet Shop
Cineplex
Factory
M.T.N.L
Shops
Cold Storage
Malls
Cooling Plant
Milk Dairy
Tea Stall
Courts
Vehicle/Automobile Service
Station
Clinic/Pathlab
Ware House/Godown
Piaos
North MCD
Govt. Offices/PSU/Bank
Police Department
East MCD
Dhaba
Haircutting Saloon
D.S.I.I.D.C
Note: All columns in the form marked * are mandatory and the Service area of ZRO Location may be searched
on-line under Contact us link or applicant may confirm it from nearest neighbour or contact nearest ZRO office.