Form -1

JODHPUR VIDYUT VITRAN NIGAM LIMITED

Application cum agreement form for new electric connection(Regular/Temporary) and other
miscellaneous activities such as load extension/reduction, Name Change (owner remaining
same), connection transfer, connection shifting, change of category etc.

The Assistant Engineer ( ),

Jodhpur Vidyut Vitran Nigam Limited,
………………………………………………..

1. Name of Applicant ((in block letters):

First Name Middle Name Last name

Father’s /Husband’s Name:

First Name Middle Name Last name

2. Full Address of the premises:

House/Plot/Shop No.: Locality:

Khasra no. /Street: Village:

Tehsil/Town/District: Pincode:

Tel. No.: Mobile

Email ID:

3. Purpose of Supply:

(Residence, Office, Shop, Hotel/Restaurant, Hospital, Theatre, Educational Building,

Workshop, Pump set, Flour Mill, Factory etc.)

4. Status of applicant: (a) Owner(b) Tenant(c)Occupier

5. Type of Application : Permanent Temporary
(i) New Connection: KW/HPCD KVA

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 (ii) Load Extension/Reduction
A/C No. K. No.

Existing New
Connected load (kW) To
Contract Demand (kVA) To

(iii) Shifting of connection

Account No. K. No.
From To

(iv) Change of Name

Account No. K. No.
From To

(v) Change of Category

Account No. K. No.
From To

(vi) Transfer of connection

Account No. K. No.
From To

6. Details of my/our property, If person(s) do not posses any such land/ property, a ‘Nil’ may
be mentioned against that.
Residence / Building
Constructed area (sq. mtrs) Land area (sq. mtrs)
Village District

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 Agricultural Land / Shop
Situated at Khasra No.

Factory building & machinery

Situated at District

7. Documents required - As per Checklist attached with the application.

8. Details of Installation:
S.No. Description of Load Nos. Wattage/HP of each Total Wattage/
HP
A. Light & Power Load
1. CFL/LED 7/15 W
2 Bulb/Fan 60 Watts Watts
3. Tube Light 40 Watts Watts
4. Light Plug (5 Amp.) 60 Watts Watts
5. Television – Colour 100 Watts Watts
- B&W 60 Watts Watts
6. Power Plugs (15 Amps.) 500 Watts Watts
7. Fridge 250 Watts Watts
8. Desert Cooler 250 Watts Watts
9. Geyser 1500 Watts Watts
10. Air-Conditioner 1/1.5 Ton 1500/2200 Watts Watts
11. Any other Appliance Rated capacity or as
per testing
Total
Total connected load ………………………………….KW/HP
(a) Connected Load for sanction …………………………KW/HP.
(b) Contract demand …………………………………… KVA.
Note:

(a) If any equipment is connected with plug point, equipment’s load or plug point rating,
whichever is higher shall be taken. In such case, load of plug point shall not be counted
separately.

(b) The higher rating of only one equipment shall be considered if both geyser and air
conditioner are installed.

(c) Load of fire protection equipments shall not be considered for assessing the connected
load.

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9. (i) I/We hereby agree to deposit with the application, the charges as prescribed in TCOS.

(ii) I/We further require the Nigam to supply me/us necessary meters for measuring the
quantity of electrical energy supplied and meter box. I/We shall be solely responsible for
any loss or damage to the Nigam’s Meters and other apparatus installed at my/or
premises. (Strikeout in case applicant wants to provide his own meter).

(iii)I/We also undertake to take from the Nigam, the supply of electrical energy for my/our
bonafide use for a period not less than one year from the date of commencement of
supply (in case of temporary supply, for a period ……………………..) and I/We hereby further
agree to pay for the said supply at the tariff in force from time to time & also to pay all
such other charges as become due by me/us from time to time in accordance with the
provisions contained in Nigam’s Terms & Conditions for Supply of Electricity -2004 or any
other Rules & Regulations.

iv) I/We agree and shall have no objection at any time to the rights of the Nigam to supply
electricity to any other applicant from the service line or apparatus installed on my/our
premises.
v) I/We agree not to use electrical energy during the restricted hours intimated by the
Nigam.
vi) In the event of this connection being given, this application shall be treated as an
agreement for the connect ion with effect from the date the connection is given till such
time as it is either replaced by fresh agreement or it is terminated as per the provisions of
Terms & Conditions for Supply of Electricity-2004.

10. The applicant shall submit self certification of the installation/ permission of electrical
Inspector as per provisions.

11. For large industrial category, the applicant shall execute an agreement with the Nigam
separately in Form-II, as and when asked to do so.

This agreement shall be read and construed as subject in respect to all the provisions of
Terms and Conditions for supply of Electricity-2004 and Tariff for supply of Electricity as
enforced from time to time, which shall constitute a part of this agreement. The relevant
provisions of the Electricity Act, 2003 and the rules and regulations made there under or
any subsequent amendments or modifications thereof, shall be the governing provisions.

I/We understand that submission of any wrong information in this application, shall make
the agreement itself liable for cancellation and connection if released, shall also be
disconnected forth with on this ground alone.

Note: (i) Strike out the clause/portions not applicable.

(ii ) Every Page of Application form should be signed by the applicant.

Signature of Applicant/Consumer
Address_________________________
_________________________
_________________________

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 Signature and Address of witness
(alongwith K.No.)_____________________________
_________________________
_________________________
_________________________

Dated:_____________________

Enclosure Check list

FOR OFFICE USE ONLY

Accepted on behalf of the Jodhpur Vidyut Vitran Nigam Limited

Date _______________ (Signature)

--------------------------------------------------------------------------------------------------------------------------------
ACKNOWLEDGEMENT

Received the application of …………………………..on ……………………….. and registered at

Serial No. ………………… which should be quoted in all further correspondence.

Signature & Designation

of the person receiving
application

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 Checklist for completed Application Form

# Activity Yes/No
1) Proof of ownership of the premises: - (any one of the following documents
to be provided for either Owner/ Tenant Or Occupier)
a) In case of Owner of the Premises (any one of the following documents)
i. Title Deed (Registry); OR
ii. Possession letter issued by Local Bodies or any other
Government authority like RIICO, Industries Deptt. etc.; OR
iii. In Rural areas, the certificate issued by Revenue authorities
iv. Partnership deed; OR
v. Patta; OR
vi. Sale deed: OR
vii. Allotment letter; OR
viii. Court order; OR
ix. Any other document(specify); OR
b) In case not the Owner of the Premises - Proof of tenant or occupier:
(any one of the following)
i. Rent deed/ consent of owner on Non-judicial Stamp paper worth
Rs.50/-; OR
ii. Indemnity bond on Non-judicial Stamp paper worth Rs.500/- in
case there is no consent of owner.
2) Authorization Document or ID and address proof:(any one of the following
documents to be provided)
i. Authorization Document issued by the competent authority (in
case of Firm/ Company); OR
ii. Voter ID/ Ration Card/ Adhar Card/ Bhamashah Card/ Passport/
Driving License (In case of individual applicant)

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