LtNewEng BPL
LtNewEng BPL
LtNewEng BPL
Date:………………..
To,
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Sir,
I/We request you to supply electricity to my/our premises. The requisite information
is furnished below :-
1. Consumer –
(a) Name of the person/organization : ……………………………………………………
(b) Name of father/husband/Director/ : ……………………………………………………
Partner/Trustee
be shifted
mail : ……………………………………………………
LT Supply :
6. Proposed Load –
(b) For other categories please fill up the following (Attach duly signed separate list if
required)
Item Load per item (Watts) No. Total Load
(Watts)
HT Supply
11 KV 33 KV 132 KV 220
KV
(Please strike-off category not applicable and tick the category applicable)
(b) ………………………………………………………………………………………
(c) ………………………………………………………………………………………
(d) ………………………………………………………………………………………
…………………………………………………………………………………………….
19. Whether the requisite consent/NOC (where applicable according to the list of Pollution Control
Board) has been obtained from M.P. State Prevention and Control of Water Pollution Boards,
Bhopal as per statutory requirements
20. Any electricity dues outstanding in the licensee's area of operation in the consumer's name
Yes/No
21. Any electricity dues outstanding for the premises for which connection applied for :
Yes/No
22. Any electricity dues outstanding with the licensee against any firm with which the
consumer is associated as an Owner, Partner, Director or Managing Director Yes/No
(For serial nos. 20, 21 & 22 if answer is 'Yes' in any case please provide details)
(c) I/We will deposit electricity dues, every month, as per the applicable electricity
tariff and other charges.
(d) I/We will own the responsibility of security and safety of the meter, cut-out and
the installation thereafter.
Date : …………………….……..
Place : ………………….……….
Note : The following documents shall be attached with the application form :-