NPDCL APPLICATION FORM.p

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NPDCL NEW CONNETION APPLICATION FORM

SERVICE TYPE :
Domestic Commercial Commercial-Hoardings 6A- Street Light 6B-Public Water Works
6A General Issues 6A-Religious Places (Temples, Church, Mosque, Govt. Schools etc.)
CONSUMER DETAILS :
CONSUMER NAME (CAPITAL LETTERS):
Consumer Father Name :
Social Group : SC ST Others (Mension Caste Name Here
Consumer Type : Individual Other Legal Personal
Private Limited Company Public Limited Company
Registered a Partnership UN Registered Partnership
Purpose of Supply:
LOCATION OF PREMISES WHERE SUPPLY IS REQUIRED:
House No.: Street :
Circle : Adilabad Khammam Karimnagar Nizamabad Warangal
Division: Sub-Division:
PIN Code : Location Type:
Location Name : Existing Service No. if any:
LOAD DETAILS :
Note: (Category & Sub Category details are given below)
S.no Category Sub Category (Devices) No. of Items

ADDRESS FOR COMUNICATION :


Door No.: Locality / Land Mark:
District : Mandal: Village / Ward:
PIN Code: Mobile No. Email ID:
Aadhar Card No.: Ration Card No.
INFORMANT DETAILS:
Informant Name : Informant Relation

Delivery Type: Manual


DOCUMENT LIST:
1) Application Form 2) Identification like Ration Card/ Voter Card/ Pan Card/ Adhar Card
3) Caste Certificate (Mandatory if SC/St)
4) Ownership Certificate / Sale Deed/ Gift Deed/ Indemnity Bond incase of Leased Premises
5) Municipality / Gram Panchayath Permission Letter
6) Photo
Signature of the applicant

Shanvi Meeseva, Dharmapuri. 9014137387 Type your


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