EASTERN POWER DISTRIBUTION COMPANY OF A.P.

LIMITED
Customer Service Center: SEETHAMADHARA (CSC)
OPERATION CIRCLE,VISAKHAPATNAM
TRANSFER APPLICATIONS FORM

I………………………………………………………………….…………….here transfer my Service Connection

No………………………………at Door No…………………………………….Street………………………….………………………..

Town ………………………………….…………….. To Sri/Smt/Kum……………………………………………………........with

Security Deposit Rs……………………………… (Rupees………………………………………………………………………………).

Pledged by me. As I have ( 1 ) left the house or ( 2 ) sold the house or ( 3 ) mortgaged and I have
nothing to do with the service from hence forth, as I have for gone all rights in the service
connections.

Signature of the Transfer

I…………………………………………………………………………………..…………..hereby agree to transfer said service

Connection of Sri/Smt./Kum………………………………………….……at door no………………………………

Street………………………………………………..town…………………………………….with the Security Deposits as I

have taken possession of the said premises forms/Smt./ Kum…………………………………………………………I

hereby agree to abid by the conditions of the agreement for requisition entered into by

Sri/Smt./Kum…………………………………………………………………With the Licensee/Discom.I agree to execute

the agreement and L.T requisition and abide by the conditions laid down by the licensee/Discom if
required.

Signature of the Transferee