NEW CONNECTION APPLICATION FORM

Please fill the form in CAPITAL LETTERS (please on the approprriate box)

Please attached a
recent passport size
Notification No. colour photograph of
applicant (Self
CA No. attested)

CONNECTION SERVICES (S) REQUIRED

New Connection Type : Permanent Connection Meter Type: Post Paid
Permanent / Temporary Prepaid / Post Paid

1 GENERAL PARTICULARS
Title : Mr. ( Mr. / Mrs. / Dr. /Prof. Others ) Age Years Date of Birth
Name of Applicant / Organization: Ashok Kumar Gupta
Name of Father/ Husband/ Mother/ Late Shri Ramnath
Director/partner
Type of Accommodation
( Owned / Rental/Lease / Company Provided / Govt.Provided / Govt. House / DDA Flats / CGHS Flat / J.J.Cluster / Others )
2 Complete Supply Address
House/ Shop no./ Flat No./ Plot/ Premises/ Floor / Street GANDHI VIHAR#JJ COLONY#20 POINT COLONY#B 200##110009
/Area / Location

Pin
Landmark
Mobile No. / Phone No. 9958735132 /
E-Mail: [email protected]
3 Billing Address:
Same as above If different, Please specify below
House/ Shop no./ Flat No./ Plot/ Premises/ Floor / Street
/Area / Location

Pin
Landmark
Mobile No. / Phone No. 9958735132 /
E-Mail: [email protected]
4. Category for Electricity Usage (As per applicable Traiff Schedule): Domestic CustomersLighting
i Domestic Category-Residential/Hostels/Hospitals*/ vii DJB
Educational Institutions*/Religious/Charitable*/Others
ii Non Domestic-Banks/ Chemist/ Tailors/Others viii Railway Traction
iii Industrial ix DMRC
iv Agricultural x Advertising (No. of Hoardings)
v Mushroom xi Temporary Supply
vi Public Lighting
Note: the applicant shall refer the applicable tariff schedule for correct tariff category. In case of any doubt, the applicant shall seek
help of the licensee. *based on the funding pattern as per traiff schedule.
5.
PAN NO. (for correct deduction of TDS, if any)

CIN NO. : U40109DL2001PLC111526, E-mail : [email protected], Website : www.tatapower-ddl.com

 6. Purpose of Supply (e.g. Shop/House/ Factory/ Godown/Parking etc.

7. Total Applied Load 1 KW KVA

8. Please indicate whether you want to purchase your own CEA approved meter having YES NO
additional features as approved by the commission.
9. List of Document attached:
A. Identity Proof submitted along with this application form > if (ii) Proof of ownership or occupancy of premises for which
applicant is a person (tick any One) electricity connection is required (tick any one)
i. Electoral Identity Card i. Certified copy of title deed
ii. Passport ii. Certified copy of registered conveyance deed
iii. Driving License iii. GPA
iv. Ration Card having photograph iv. Procession Letter/ Allotment Letter
v. PAN Card v. In case of tenant
vi. Aadhar Card a). Rent receipt / Lease agreement
vii. Photo identity card issued by any government agency b). No Objection certificate from Landlord
If applicant is and organization (tick applicable) Certificate of c). Proof of Ownership of Landlord
incorporation/ registration issue by the registrar. vi. Others
10. Declaration Form (Attached) Yes No
Note: for bonafide consumers residing in JJ clusters or in other areas with no specific municipal address, the licensee may accept either
ration card or electoral identity card mandatorily having the same address as a proof of ownership/ occupancy of the premises.
Customer Name & Signature

CIN NO. : U40109DL2001PLC111526, E-mail : [email protected], Website : www.tatapower-ddl.com

Note: (pleaseon the applicable box) Declaration

I,_______________Ashok Kumar Gupta_____________________________Son/Daughter/wife of______________ Late Shri

Ramnath _________________Resident of
____________ GANDHI VIHAR#JJ COLONY#20 POINT COLONY#B 200##110009
____________________________________________________________(hereinafter referred to as “Applicant”, which term shall
mean and include executors, administrators, heirs, successors and assigns), do hereby swear and declare as under:
Or
The _________________ ______________________________, a company incorporated under the provisions of the Companies
Act,1956 Or as amended,, having its registered office
at,_____________________________________________________(hereinafter reffered to as “Applicant” which expression
shall,unless repuguant to the context or meaning thereof, include its successors and assigns), through its Authorised representative
Mr. ______________________________, do hereby swear and declare as under:
Or
A sole proprietorship/a partnership firm having its office at
__________________________________________________(hereinafter referred to as the applicant which unless the context
otherwise provides includes its successors and assigns), through Mr. ___________________________________, who is a partner
or an authorized representative do hereby swear and declare as under:

That the Applicant isit a lawful occupant of the premises at______________ GANDHI VIHAR#JJ COLONY#20 POINT COLONY#B
200##110009 _______________________(hereinafter the “Premises”).

That the Applicant has requested the Licensee to provide a service connection at the above-mentioned premises in the Applicant’s
name for the purpose mentioned in the application form.

That in furishing the present Declaration , the Applicant has clearly understood that should any of the statements in this declaration
prove to be false or incorrect at any later stage, the Licensee shall be within his lawful right to disconnect supply to the premises
without any prior notice and proceed to adjust electricity supply dues payable by the applicant against consumer security deposit
and/or recover the same in accordance with Law.

That the Applicant has complied with all requirements under all statute for the time being in force and the Applicant himself
/herself shall be held legally responsible for any issue arising out of any such noncompliance for which the Licensee may initiate
action in accordance with applicable Law.

That I, the Applicant hereby agrees and undertake:

1. That in case the Applicant is not the sole owner of the premises, no objection certificate for seeking electricity connection
from the co-owner has been obtained.
2. To indemnify the Licensee against all proceedings, claims, demands, costs, damages, expenses that the Licensee may
incur by reason of a fresh service connection given to the Applicant.
3. That to the best of applicant’s knowledge, all electrical works done within the premises are as per Central Electricity
Authority (Measures relating to safety and Electricity Supply) Regulations, 2010 as amended from time to time.
4. That the internal wiring at the premises has been tested by a Licensed Electrical Contractor and the test certificate is
available with the applicant.
5. *That the building has been constructed as per prevalent building Bye-laws and the total height of the building
 does not exceed 15 (fifteen) meters of the date of seeking service connection ; Or
is more then 15 (fifteen) meters and Fire Clearance certificate is available with the applicant.
6. *That there is a provision of lift in premise and the applicant has obtained the lift fitness certificate from the Electrical
Inspector for the lift in the said premises and same is available with the applicant.
7. That the applicant has applied for the correct category of tariff as per the applicable tariff schedule. For either of the
following categories of connection, the applicant has the relevant documents available with him.
*Applicant for selected consumer category

CIN NO. : U40109DL2001PLC111526, E-mail : [email protected], Website : www.tatapower-ddl.com

 a) Industrial
Valid industrial License/Factory License/ Lal Dora Cerfiticate is case of rural village

b) Agricultural Consumer
i) Certificate of Residence From Block Development Officer
ii) No Objection Certificate from Development Commissioner/ Block Developlment Officer Delhi Jal Board
for tube wells.
c) Non- domestic for khokhas and temporary structure
i. Teh Bazari Receipt Number
ii. No Objection Certificate for Khokha/Temporary Structure for single delivery supply
d) Charging station for electric vehicles
An undertaking by the applicant that the charging station for electric vehicles is as per the specifications
as may be specified by Central Electricity Authority or Bureau of Indian Standards from time to time.
8. The above referred applicable documents/certificates indicated at various points are available with me and can be
inspected by the Licensee at any time. In case of any failure to produce the same , the Licensee may disconnect the
connection granted owing to such failure, reluctance on my part to produce/allow the inspection of said
documents/certificates.
9. That I will provide a copy of any of above applicable documents to the Licensee pursuant to request of any external
government agency, judicial forum or any other authority seeking such information.
10. That my industry /trade has not been declared to be releasing obnoxoius hazardous/pollutant by any government agency
and that no oders of any court of judicail authority would be breached by running of my industry /trade or granting any
electricity connetion to the same.The Licensee is indemnified against any loss accrued by the applicant on this account.
11. The Applicant further agrees to indemnify and hold harmless, the Licensee , in case of any injury or incident an account
of any fault in electricity work in the premises. The Licensee shall not be liable for any mishap or incident occurring at the
premises to the applicant an account of any faulty/defective/ inferior quality wiring at the premises for which the
connection is being applied.
12. To pay the electricity consumption bills and all other charges at the rates set out in the Licensee’s Tariff Schedule and
miscellaneous charges for supply as may be in force from time to time, regularly as and when the same becomes due for
payment.
13. To deposit the additional security deposit and additional service line cum development (SLD) charges, if any from time
to time based on the prevailing Orders/rules, directions and Regulations of the Commission.
14. To abide by the provision of the Electricity Act, 2003 all applicable laws, conditions of Supply/Tariff Orders and any other
Rules or Regulations as may be notified by the Commission, as applicable from time to time.
15. That Licensee shall be at liberty to adjust the electricity consumption charges due/outstading along with any other charge
against the Consumer Security Deposit paid by the Applicant, in the event of termination of the agreement prior to expriy
of the contracted period or in case of any contractual default as per provisions of regulations/rules /orders/directions of
the Commission.
16. That as per Delhi Electricity Supply Code and Performance Standards, 2017 or as amended from time to time, I shall
provide suitable and adequate space for installation of the meter/electriclty equipments where the Licensee may have
ready access to the same.
17. To allow clear and un-encumbered access the meters for the purpose of meter reading and it’s checking etc.
18. That the Applicant would let the Licensee disconnect the service connection under reference, in the event of any default,
non-compliance of statutory provisions and in the event of a legally binding directive by Statutory Authority (ies) to effect
such an order. This shall be without prejudice to any other right of the Licensee including that of getting its payment as
on the date of disconnection.
19. I have installed or shall install an Earth Leakage Circuit Breaker device(ELCB)/MCB for single phase connection & 4
pole MCCB/ELCB/RCCB for three phase connection before using power supply service at my aforesaid premises where
electricity connection has been sought. I too declare that, earthing is done at applied premise and equal load is
distributed on all phases. On my failure to install the said device(s), I shall be solely held resposible for any mis-
happening, safety breach/ incident due to negligence etc. at the aforsaid premise.TATA Power-DDL shall be free to
proceed with the cancellation of electricity connection and disconnection etc.
20. All the above declaration given by the Applicant shall be construed to an Agreement between the Licensee and the
Applicant

Signature of the Applicant

CIN NO. : U40109DL2001PLC111526, E-mail : [email protected], Website : www.tatapower-ddl.com

Name of the Applicant
Ashok Kumar Guota

SINGED AND DELIVERED

In presence of witness
Name of witness

*Select whichever is applicable

CIN NO. : U40109DL2001PLC111526, E-mail : [email protected], Website : www.tatapower-ddl.com