Customer No.

________________
(For Offce Use)

16.1 Application for Supply / Additional Load / Shifting / Extension of Services / Change of Name / Changeover of Supply
Under Section 43 of Electricity Act 2003 hereinafter called Act and MERC (Electricity supply code and other
conditions of supply) Regulation 2005, hereinafter Regulations .

Note: Intending consumers are requested to see that this form is fully, clearly and legally lled and signed with date
before sending to the company. Please tick the box, whichever is applicable.
(Please provide complete details)

I/We hereby submit application for Af x passport size

photograph and sign across
New Connection Additional Load Reduction of Load
Change in Contract Demand Change of Name Shifting
Changeover of Supply Change of Tariff Category

To the premises owned/occupied by me/us and situated within the area of speci ed in the Note: Please do not staple the photograph

Reliance Infrastructure Ltd License, 2011

1) Applicant s Name: Mr/Mrs/Miss/M/s

(First Name) (Middle Name)
(in block letters)
(Surname)

Occupation/Designation

Address at which supply is required:

Flat No./Building Name

Lane/Street

Landmark

Suburb /City Pin Code

Area of Premise Sq mtr Email

Phone No. Mobile No.

Preferred Bill Languag Marathi Hindi Gujarati English

e is:

Bank Account Number

Bank Name/Branch

Existing/ Nearest Consumer Account number Meter Number

Type of Premises

Owned Rented Lease Others (Specify)

Category of Premises

Chawl Hut Multi storied Building Bungalows Others (Specify) _________________________

Incase of Premises on Rent or Lease not owned by Applicant

Name of Owner

Flat No./Building Name

Lane/Street

Landmark

Suburb/city Pin Code

2. The following are my requirements (Please tick appropriate box) (To be lled by LEC)

2.1 Residential BPL Charitable/Religious Non Commercial/Educational Others (Specify) ___________________________

Commercial Of ce Construction/Power Others (Specify) ____________________________________________________________
Industrial (Type of Industry) ______________________________________________________ Others (Specify) ____________________________

2.2. The connection will be

New Service Tapping

1
2.3 Details of the Apparatus No. of Points Wattage of Each Voltage Total Wattage

a) Bulbs

b) CFLs

c) Tubelights

d) Fans

e) Geysers

f) Ovens/Microwave

g) Air Conditioners

h) Refrigerators

i) Television

j) Plug- 5/15/30 Amp

Total no of Points Total Wattage Contract Demand

Total No. kw kva
(Incase of any other apparatus attach a separate sheet with speci c Wattage)

3. The wiring carried out/certi ed by the following Licensed Electrical Contractor

Name: ________________________________________________________________________

Address: ______________________________________________________________________

Telephone number _____________________________________________________________

Email _________________________________________________________________________ Rubber Stamp

Licence No. Valid up to:

4. Applicant s Present/Correspondence Address

Flat No./Building Name

Lane/Street

Landmark

Suburb/City Pin Code

5. For Changeover of Supply

5.1 Meter Number CA number

5.2 The meter would be provided by

Existing Distribution Licensee New Distribution Licensee Self
6. Change of tariff category: From _______________________________ To ___________________________________

7. Important Notice

7.1 Under Rule 45 of the Indian Electricity Rule 1956, no electrical installation work including additions, alterations, repairs and adjustments to existing
installation, except such replacement of lamps, fans, fuses, switches, low voltage domestic appliances and ttings as in no way alters its capacity
or character, shall be carried out upon the premises of or on behalf of any consumer or owner, for the purpose of supply to such consumer or
owner, except by an electrical contractor licensed in this behalf by the State Government under the direct supervision of a person holding a
certi cate of competency issued or recognised by the State Government.
Where any electrical installation work of the nature speci ed above has been carried out otherwise than under the direct supervision of a person
holding a certi cate issued by the State Government and by the electrical contractor licensed by the State Government in this behalf, the
consumer owner or occupier, the contractor (if any) or the person through whom the work is being or was carried out and the person under whose
immediate supervision the work is being or was carried out, shall each be punishable with ne which may extend to Rs 300/- under the Rule 139
of the Indian Electricity Rule 1956
7.2. Indicative list of the document/NOC/Clearance Attached
I have read and agreed to the notice above and make the following declaration
a) To abide by the provisions of the Electricity Act 2003 and Maharashtra Regulatory Commission
(Electricity Supply Code and other conditions of supply)
b) To pay for the supply of electricity based on the prevailing tariff rates of Reliance Energy
c) To pay all the charges which are due, in accordance with the above Regulations and approved schedule of charges of the Company
d) To pay the security deposit as per the provisions of above Act and Regulations

Applicant s Signature_______________________________ Date:

For Of ce Use

Business Partner Number ________________________________________________________________________________________________________

Contract A/c Number ___________________________________________________________________________________________________________

2
 Terms and Conditions
1) Please note that no consumer/applicant who have defaulted in payment of electricity bills and other charges shall be allowed for
a change over without clearing dues of the existing distribution licensee.

2) The consumer/applicant shall submit the proof of its payments of last bill as served by the existing distribution licensee and other
relevant documents as required under Electricity Supply Code

3) The consumer/applicant shall not to be able to change the name, purpose or classi cation of category for which the electricity
has been provided by previous distribution licensee at the time of changeover.

4) The consumer/applicant shall be under an obligation to provide the complete details of all the payment arrears/court proceeding
or any dispute if any

5) The premised of the consumer/applicant shall be inspected to con rm the classi cation, connected load, technical issues if any,
etc and if any default is found, the application may be rejected for the same.

6) Please note that that the existing distribution licensee shall have the right to adjust the security deposit of the consumer/applicant
towards the last due bill/arrears

7) The consumer/applicant shall ensure that if the sanction loads of the consumer/applicant are equal to or higher that 50 KW, the
consumer/applicant shall have to enter into a new agreement with the new distribution licensee at the time of making an
application.

8) Please note that if the consumer/applicant has opted for new distribution licensee s meter or opt outs for his own meter, the
same shall be tested by new distribution licensee in its laboratory in the presence of existing distribution licensee before
installation of the said meter.

9) Please note that if after making an application to the new distribution licensee, the meter reading for the nal billing shall be
taken jointly by the new distribution licensee and existing distribution licensee for the preparation of last due bill and the same
meter reading shall be the opening meter reading for new distribution licensee and such meter reading statements shall be
signed by all, i.e. existing distribution licensee, new distribution licensee and the consumer/applicant. In case the consumer/
applicant is not present for the reading, the readings taken jointly by existing distribution licensee and new distribution licensee
shall be nal and binding.

10) The consumer/applicant shall be liable to pay the outstanding bill amount as raised on nal meter reading on or before due date.

11) The existing distribution licensee or wheeling distribution licensee will be entitled to follow the provisions of law for disconnection
of supply under Section 56 of the Electricity Act, 2003 in case of any default of payment by consumer/applicant.

12) Any change-over consumer/applicant who proposed to change the name, purpose, category shall continue to abide by the
conditions of the changeover even after change of the name/purpose/category

13) The new/supply distribution licensee shall be entitled to initiate appropriate proceedings for misuse of supply against the
consumer and accordingly advice the wheeling/existing distribution licensee to carry out disconnection as per the provisions of
the Electricity Act, 2003

14) The existing/wheeling distribution licensee shall have the right to inspect the meter, and cut out seals from time to time and take
meter readings for all changeover consumers.

15) The existing/wheeling distribution licensee will be entitled to do the assessment as provided U/S 126 (6) of The Electricity Act,
2003 and shall provide the said information to the new/supply distribution licensee for billing and recovery purpose and for
making the payment to existing/wheeling distribution licensee

Applicant s Signature _______________________________ Date:

For Of ce Use:

Business Partner Number ________________________________________________________________________________________________________

Contract A/c Number ____________________________________________________________________________________________________________

Registered of ce: H Block, 1st Floor, Dhirubhai Ambani Knowledge City, Navi Mumbai 400710