MANIPUR STATE POWER DISTRIBUTION COMPANY LIMITED

One Time No Due Certificate Form

In respect of Electricity Consumption Charges
Form No. MA00000001
Sl No Subject Details In Block Letter
1 EMPLOYEE NAME

2 DESIGNATION

3 MGEL/CPIS/EIN

4 REGULAR/CONTRACT/AD-DOC

5 MOBILE NO./CONTACT NO.

6 EMAIL

6 EMPLOYEE HOUSE NO./QUARTER NO

7 PRESENT POSTING

8 NAME OF HUSBAND/FATHER

9 OFFICE/DEPARTMENT NAME

10 EMPLOYEE PRESENT ADDRESS

11 EMPLOYEE PERMANENT ADDRESS

12 CONSUMER NO

13 CONSUMER NAME

14 METER NUMBER (IF METERED)

15 PREPAID/POSTPAID (IF METERED)

16 CONSUMER BILLING ADDRESS

SELF/RELATIONSHIP TO CONSUMER (Eg.

17
Consumer is my father)
MSPDCL, ELECTRICITY SUB-DIVISION
18
PREPARING/ISSUING ELECTRIC BILL

CONCERNED DDO VERIFYING THE EMPLOYEE'S DETAILS

NAME DESIGNATION SIGNATURE WITH SEAL

MSPDCL NDC ISSUING SUB-DIVISION MANAGER

NAME SUB-DIVISION NAME SIGNATURE WITH SEAL

MSPDCL NDC VERIFYING DEPUTY GENERAL MANAGER, DIVISION OFFICE

NAME DIVISION NAME SIGNATURE WITH SEAL