Cat-I (Domestic) II (Commercial & Non-Domestic) V(Agriculture)
VI (Street Light PWS) VII (General Purpose) VIII (Temp. Supply)
Type of Service::New Connection Addl. Load Category Change Title Transfer .
To,
The Superintending Engineer,
Operations, APEPDCL
…………………….
I /We request you to supply electricity at Low Tension to my /our premises as mentioned below:
1.
a. Name of the applicant in whose name connection is required ( IN CAPITAL LETTERS )
First Name Middle Name Surname
b. Father’s Name / Husband’s Name
2.
Location of the Premises where supply is required
House No
Village /town
District
Phone /Cell No
Email:
Street
Mandal
Pin
Aadhar No
S.F No for Agl SCs
3.
Details of the supply required a.Nature of supply b.Contracted
Load Requested c. For adl Loads SC No:
Phase:: single phase
Existing Load::
4.
a. For Category changes::
b. For Name transfers::
Existing
Category
Present
Consumer Name
5.
Social Group:: SC ST others
Date::…………………… Signature:
Proposed
Category
New
Consumer
Name
Three Phase
Adl Load Required::
( please tick ( ) in appropriate box)

6.
Undertaking :: i.
I /we undertake and agree to pay the tariff and miscellaneous charges prescribed by the company and to abide by the General Terms and Conditions of Supply notified by the company from time to time, which shall govern the supply of electricity to me/us in all respects. ii.
I /we shall undertake to execute an agreement in the prescribed form, if so called upon by the company. Whether such an agreement is executed or not , this application itself shall oblige me /us to confirm and above by the General Terms and Condition of Supply notified by the company from time to time. iii.
I /we undertake to provide suitable arrangements for “ way leave” at my / our own cost. iv.
I /we undertake to take up any disputes arisen on account of the ownership documents produced by me/us based on which the supply is extended and I /we also understand that merely taking of electrical supply or payment of bills raised by the licensee for consumption of electricity will not constitute evidence for the purpose of lawful occupation of the premises in any municipal record, revenue record or any court of law.
7.
Supporting Documents enclosed a.
Completed and signed application form : { yes / No } b.
Identity Proof ( any one of the :- Ration card, Aadhar Card, pass port, Election Id, PAN card etc)
{ yes / No } c.
i. Proof of Ownership ( any of the following 1. Sale deed, 2. Allotment, Possession letter,3. Municipal
Tax receipt, 4. Gift deed, 5. Will deed or any other valid document ) { yes / No }
OR ii. An indemnity bond (to be executed on Rs.100/-Non-Judicial or Rs.100/- Special adhesive stamp paper) drawn by the owner of the premises in favor of the company whereby the owner of the premises undertakes to indemnify the company of any loss causes to the company by the applicant who is the tenant / occupant of the premises) arising out of the release of service to the tenant / occupant.
{ yes / No }
OR iii. Any applicant, who is not covered under (a) and (b) above , shall execute an INDEMNITY BOND
(to be executed on Rs.100/-Non-Judicial or Rs.100/- Special adhesive stamp paper), indemnifying the licensee against any damages payable on account of any dispute arising out of supply of power to the premises. He shall also pay three times of Security Deposit. d.
Wiring Certificates for all LT services.
{ yes / No } e.
Name transfer form and indemnity bond for name transfer applications. { yes / No } f.
Registration Details::
Name of Section
Name of Sub-
Div
Name of ERO
Amount paid
Registration
No:
Date of
Registration
Location code
Receipt No
Signature of the Call Center Operator
2