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Power Supply Application Form A-I Residential

New Connection
Additional Load

Non Domestic/Non Industrial (Commercial)

. ___________________________ (
/ :)
Consumer No.

( (1),
.)

(Neighbours for New Connection / Self for Additional Load )

(In case of Additional Load only Tables A (1), B & E are required to be filled)

Subject to the provisions of MERC (Electricity Supply Code & Other

(

Conditions of Supply ) Regulation, 2005.
) -2005

/ / / .
I/We hereby submit this application for New connection/ Additional load for supply of electrical energy at the premises mentioned below.

. Note: Please tick

.) 
1) * ( ) (
)

appropriate box and strike off which is not applicable.

Details of Applicant and Premises{*- Mandatory Fields }

First name
/ Name of Father/Husband
Surname

A.

Applicants Name (IN BLOCK LETTERS)

(As per the proof of Identity)

2)

(
) * Address of premises at which supply is required (Please furnish
complete details) (Minimum as per the Address proof) (


)
. / .
/ /

House No./ Survey No.:

Lane / Street/ Landmark :

:
Flat/Gala/Village
:

/ .

/ /

Society Name/ Plot No.:

/
Taluka/City & District :

3)

Pin Code :
.:
(Phone No)

Email Id:
4)

Self Owned

Type of premises

Rented

.:
(Mobile No)
/ ( )
Occupier / Other (Pl. Specify)

( )

5)

Name & Address of the Owner :

(If not self owned)



B . .

Power Supply Requirement

()

3 ()

Single Phase (LT)

Three Phase (LT)

C.

( ): *
Existing Connected Load (KW)

/ ( ):
New /Additional Load (KW):

()
Contract Demand (KVA)

a)
b) / #
c) #

General
SC/ST#
BPL #
D. . Declaration :
# Documents as per G (c) to be enclosed () 
/ ;
2003
(
) 2005 / .




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/ ______________________________________________
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Applicants Classification :

(
www. mahadiscom.in .) (For English version of declaration please refer our website : www. mahadiscom.in)

.
All submitted documents are verified by me and thumb impression done before me .

(......, , )
( Name, Designation & Sign of Representative of MSEDCL)

/ :
Signature of Applicant / Thumb Impression & Date

(

)(In case of thumb impression the same to be done before the representative of MSEDCL)

....

Annexure to the Power Supply Application Form

.

( --1)
E. ELECTRICAL CONTRACTOR'S WORK COMPLETION REPORT

.


Nature of Demand

No. of Points

(Form D-1)
The details of the installation and test obtained are as follows:

Total
Wattage

Insulation resistance to
earth

Wattage of each Points

Remarks

(Light)
(Fans) / A/ C
(Wall Plugs)
(Television)
(Refrigerator)
/ Water Heater / Geyser
Washing Machine
Iron / Hot Plate
Wall Plugs (Power Sockets)

Water Pump
Other

TOTAL

._____20___ .
____
____
.
Insulation test at the point of supply was carried out by me on __________20__ and the result was ____________________M between phase to earth and
__________________ M between phases

The Wiring & Load Details Certified by the following Licensed Electrical Contractor
Name _________________________________________________________
Address _______________________________________________________


E-Mail - _________________________Phone No(S)
Stamp & Signature
_________________
License No. .
Valid upto:

F. . Important Note:
1956 45
,



- / , , , ,




,
,

. (
)
Under Rule 45 of the Indian Electricity Rules, 1956, No electrical Installation work including additions alterations repair and adjustment to an existing installation
except such replacement of lamps, fans, fuses, switches, low voltage domestic appliances and fittings in no way alter its capacity or character shall be carried
out upon the premises of or on behalf of any consumer owner or occupier except by an electrical contractor licensed in this behalf by the State Government and
under the direct supervision of person holding a certificate of Competency and by a person holding a permit issued or recognized by the State Government
( As per E mandatory )

G. .

Documents Attached & Verified (Please Tick )

1. Applicable to all Applicants (Any document from a & b and if applicable from c)
a. . (
)
b. . (

Address Proof (Any one of the following)

) Identity Proof (Any One of
the following)

c. . . () ()

Other documents

Ration Card
Local Authority Tax Bill/ Receipt
Approved plan by Competent

Caste Certificate

Govt. Authority

Voter ID Card
/ UID Card/ Aadhar Card
Passport Driving License
/ Purchase / Sale Agreement
-
( )
Owners NOC with Leave & License / Lease
Agreement/ In the alternative he can produce rent receipt for last
three months (if applicant is not owner of premises)
/
/ Developer
Agreement with Land Owner/ Occupier/ Govt. Agency

Voter's
Identification Card

/
-

Collector / Govt
Authorized Photo ID

UID Card/
Aadhar Card
Passport
PAN Card
Driving License

(
) Photo Pass (Recognized

Govt. Issued Property Card or 7/12 Extract

Sr. Citizens Identity Card issued

by Govt.

on Rs.200/- stamp paper should be submitted. (format-1 enclosed)

. :
:
:

/
SC/ ST

BPL Certificate

)
License from the concerned
government department as per the
activity. (For Commercial Connections
Only)

By Govt. Department)

7/12

Society Registration

. 200/-
( -1) If none of the above documents is available then affidavit

required (if applicable) for relevant

category at C (b) & C (c)

/
. Photo ID in
Purchase/Sale Agreement

:

(
)