CENTRAL POWER DISTRIBUTION COMPANY OF A.P.

LIMITED
Application for sppl! of El"ctricit! at Lo# T"nsion
Na$" of t%" S"ction&
Na$" of t%" S'( Di)ision&
Na$" of ERO &
RE*ISTRATION No.
Dat" of R"+istration&
Location Co,"&
To
------------------------------------------
.D"si+nat", O/c"r0
I1 W" r"2"st !o to sppl! "l"ctricit! at Lo# T"nsion to $!1o#n Pr"$is"s as
$"ntion", '"lo#&
3. .a0. Na$" of t%" applicant in #%os" na$" conn"ction is r"2ir",
First Na$" &
Mi,,l" Na$"&
Srna$"&
.'0. Fat%"r4s 1 5s'an,4s Na$"&
6. .a0. Location of Pr"$is"s #%"r" sppl! is r"2ir",&
.'0. N"i+%'orin+ 1 N"ar"st S"r)ic" Conn"ction N$'"r&
.c 0. N"ar"st Lan, Mar7 &
.,0. T!p" of S"r)ic" Wirin+&
3. O)"r 5"a, Un,"r *ron,
6. T!p" of "ntr!& Enclos", in P8C Con,it& Y"s No
*. I. Pip" & Y"s No
9. Is the Pipe externally visible : Yes No
."0. Is #irin+ in t%" Pr"$is"s co$pl"t",& Y"s No
T%" ,"tails ar" as follo#s . If !"s0&
Afx the Passport
Photo of Applicant
House Number: Mandal:
Street: illa!e:
"istrict: Pincode:
Name of the #icensed $lectrical %ontractor
#icence Number
&ull Address
.f0. Ar" an! ot%"r s"r)ic"s ":istin+ in t%" sa$" Pr"$is"s& Y"s No
If !"s; Pl"as" +i)" S"r)ic" Conn"ction N$'"rs of t%os" s"r)ic"s&
.+0. If an! ot%"r s"r)ic"s ar" ":istin+ "ls"#%"r" in t%" sa$" na$" or in t%" na$"s
of sist"r conc"rn
Y"s No
If !"s; Pl"as" +i)" t%" ,"tails of t%os" s"r)ic"s
90. A,,r"ss an, T"l"p%on" N$'"r for Co$$nication&
<0. T!p" of S"r)ic" r"2ir", .Pl"as" tic7 t%" S"r)ic" applica'l"0
N"# Conn"ction
A,,itional Loa,
=0. Conn"ct", Loa, R"2"st",& >W 5P
?0. D"tails of Propos", Conn"ct", Loa, For in,strial1
A+ricltral S"r)ic"s1
For Do$"stic 1 Co$$"rcial Str""t Li+%ts1 *"n"ral
Prpos"1
Esta'lis%$"nts T"$porar! Sppl!
Service %onnection Number: %ate!ory
Service %onnection Number %ate!ory #ocation
Address 'elephone Number e(mail
address if any
D"tails of Nos. #atta+"s Total
#atta+"
Applianc" of "ac%
#i!hts
&ans
&rid!e
Mixer
)rinder
*ashin! Machine
$lectrical Iron
A+ %+
)eyser
*ater Pump
%oo,in! -an!e
Plu!s
.ther
Total Loa,
$xistin! #oad
Addl+ #oad
Total Loa,
D"tails of Nos.@
Total Loa,
Applianc" 5P1 >8A
Motors
*eldin! sets
Heaters
$lectric &urnaces
/attery %har!es
#i!hts 0 &ans
Total Loa,
$xistin! #oad
Additional #oad
Total Loa,
A0 Stats of Applicant .Pl"as" tic7 t%" s"r)ic" Applica'l"0 &
In,i)i,al R"+ist"r", Partn"rs%ip
Unr"+ist"r", Partn"rs%ip P'lic Li$it", Co$pan!
Pri)at" Li$it", Co$pan! *o)"rn$"nt Instittions
En,o#n$"nt 1 Wa7f An! Ot%"r
B0 Social *rop &
SC ST Ot%"rs
C0 Cat"+or! of sppl! .pl"as" tic7 t%" cat"+or! Appli", for0 &
cccccccat
3D0 D"tails of Application f"" pai, &
3D0 D"tails of Application f"" pai,&
D"$an, Draft for Rs Ban7 ,ra#n on D"$an, Draft Dat"
330 Spportin+ ,oc$"nts "nclos", .Pl"as" tic7 #%"r" applica'l"0 &
Cat"+or! Spportin+ ,oc$"nts to '" frnis%",
Co$$on to all LT cat"+ori"s ":c"pt
Co$$"rcial E In,strial

Co$pl"t", E si+n", Application For$
alon+ #it% t%" si+n", D"claration
Proof of O#n"rs%ip .Sal" ,"", ;
Allot$"nt1Poss"ssion l"as" ,"",; Mnicipal
ta: pa!$"nt ta: pa!$"nt r"c"ipt0 or proof of
occpanc! .L"as"1R"ntal ,"", #it% lan,lor,;
El"ctoral i,"ntit! car, or Passport or PAN
car, #it% proof of o#n"rs%ip of lan, lor,0
In,"$nit! Bon, .l"tt"r of cons"nt
fro$
lan,lor, to t"nant1l"ss""1 occpi"r0
Wirin+ Co$pl"tion R"port .fro$ a
lic"ns", "l"ctrical contractor0
T"st R"port
D"$an, Draft for n"# conn"ction
c%ar+"s
Co$$"rcial In a,,ition to t%" a'o)" )ali,
$nicipal lic"ns" for rnnin+
co$$"rcial "sta'lis%$"nt
%ate!ory 'ype
#' 1 I "omestic
#' 1 II Non(
"omestic
%ommercial
#'(II 2%3
Advertisement Hoardin!s
#' 1 III Industry
#' 1 I %otta!e
%ate!ory 'ype
#' 1 A!riculture
#' 1 I 2A3 Street
#i!htin!
#' 1 I 2/3 P*S
Schemes
#' 1 II 2A3 )eneral
Purpose
#' 1 II 2/3 -eli!ious
Purpose
In,strial In a,,ition to t%" a'o)"
8ali, in,strial lic"ns"
A,,itional Doc$"nts to '" pro)i,",
SC or ST N"c"ssar! co$$nit! c"rtiFcat" "nclos",.
Partn"rs%ip Location; 5"a, o/c"; na$"s E a,,r"ss of
Partn"rs E cop! of partn"rs%ip ,"",
"nclos",
Co$pan! Na$" of Pr"s"nt Dir"ctors E Cop! of
M"$oran,$ of Articl"s of Association
"nclos",
In,"$nit! Bon, an, D"claration
36. Un,"rta7in+&
I. I1W" n,"rta7" an, a+r"" to pa! t%" TariG an, Misc"llan"os c%ar+"s;
pr"scri'", '! t%" Co$pan! an, to a'i," '! t%" *"n"ral T"r$s an,
Con,itions of Sppl! notiF", '! t%" Co$pan! fro$ ti$" to ti$"; #%ic%
s%all +o)"rn t%" sppl! of "l"ctricit! to $"1s in all r"sp"cts.
II. I1W" s%all n,"rta7" to ":"ct" an A+r""$"nt in t%" pr"scri'", for$; if
so call", pon '! t%" Co$pan!. W%"t%"r sc% an A+r""$"nt is ":"ct",
or not; t%is application its"lf s%all o'li+" $"1s to conFr$", a'i," '!
t%" *"n"ral T"r$s an, Con,itions of Sppl! notiF", '! t%" Co$pan!
fro$ ti$" to ti$".
III. I1W" c"rtif! t%at I %a)" no ,"s to t%" Co$pan! "it%"r %"r" or
an!#%"r".
I8. I1W" c"rtif! t%at t%"r" is no cas" of T%"ft of El"ctricit!1Unat%oriH", s"
of El"ctricit!; p"n,in+ a+ainst $".
8. I1W" n,"rta7" an, a+r"" for r"co)"r! fro$ t%" ":c"ss pai, a$onts; if
an! a+ainst s"r)ic"s fon, to '" n,"r ,isconn"ction or s"r)ic"s #it% or
Unat%oriH", s" of El"ctricit! cas"s or T%"ft of El"ctricit! cas"s fon,;
an, also a+ainst s"r)ic"s cl''", for '"in+ in t%" sa$" pr"$is"s.
8I. I1W" n,"rta7" to pro)i," sita'l" arran+"$"nts for I#a! l"a)"4 at
$!1or o#n cost.
8II. I1W" r"2"st to co$pan! to pro)i," $"t"r for $"asrin+ t%" "l"ctricit!
sppli", to $"1s. I1W" #ill pa! t%" $ont%l! $"t"r r"ntals; as $a! '"
F:", '! t%" Co$$ission fro$ t%" ti$" to ti$".
8III. I1 W" n,"rta7" t%at I s%all pro)i," t%" )isi'l" s"r)ic" #irin+ pto t%"
$"t"rin+ point #it%ot conc"al", #irin+.
IJ. I1 W" n,"rta7" to pa! t%" r"2ir", a$onts; if an! ":t"nsion of LT15T
n"t#or7 is r"2ir",. Frt%"r; I #ill ta7" p t%" #or7 . Pl"as" tic7 #%"r"
applica'l"0
T%ro+% D"part$"nt On Trn7"!
J. I1W" at%oriH" APCPDCL to pro)i," infor$ation a'ot t%" pro+r"ss of
application t%ro+% SMS to $! c"ll p%on" fro$ ti$" to ti$".
Si+natr" of Applicant Si+natr" of
Ori+inal O#n"r
.in cas" of titl" transf"r0
Plac" Dat"
Si+n", '! t%" applicant in $! pr"s"nc"&
Witn"ss 3 Witn"ss 6
Si+natr"& Si+natr"&
Na$" an, A,,r"ss Na$" an, A,,r"ss
Dat"& Dat"&
.For O/c" prpos" onl!0
RECORD OF T5E APPLICATION
3. S"nt to AE1Op"ration on ------------------------
6. Wor7 allocat", to ------------------------------
a0 S"parat" portion Y"s1No
'0. No OSL1UDC1TE1UUE1BB pr"$is"s Y"s1No
c0. Conn"ct", loa, is sa$" as ,"clar", Y"s1No
,0. W%"t%"r S"r)ic" #ir" is Conc"al", Y"s1No
"0. 5T E LT Cl"aranc"s $aintain", Y"s1No
f0. W%"t%"r an! O)"r%"a, lin"s ar" Y"s1No
passin+ o)"r t%" %os"1Pr"$is"s
%0. T1F Co," 1F"","r Co,"
i0. T.C. S"al No& P.P.Bo: S"al No.
I$pr"ssion&
3. R"c"i)", fro$ t%" D"si+nat", O/c"r alon+ #it% T"st R"port on -------------
6. SC. No.-------------------------
AC>NOWLED*EMENT OF APPLICATION AND INTIMATION OF PAYMENT DETAILS
D"si+nat", O/c" Dat" of S'$ission of
Application 1R"+istration
R"+istration No. Si+natr" of t%"
R"c"i)in+
O/c"r #it% Sta$p
Total Pa!$"nt R"c"i)",
Si+natr" of
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