MAHARASHTRA STATE ELECTRICITY DISTRIBUTION CO.

LTD
Registration No.______________ Date: (For Office Use)

A-1 Application Form (To be used for Industrial connections)

Under Section 43 of Electricity Act – 2003 hereinafter called ‘Act’ and MERC (Electricity supply code and
other conditions of supply) Regulation 2005, herein after called ‘Regulations’.
Note: Intending consumers are requested to see that this form is fully, clearly and legibly filled and signed
with date before sending to the company. Please strike out words or clauses which are not applicable.
I/We hereby submit application for:- Single Phase/Three Phase-L.T/H.T Supply
 New Connection (Permanent)  Additional Load  Reduction of Load
 Change in Contract Demand  Change of Name (Alongwith XYZ or W form)  Shifting
 New connection (Temporary) from date__________ to date ___________

and request to supply energy to the premises owned/occupied by me/us and situated within the area of MSEDCL.
I/We further request you to supply me/us with the necessary meter. I/We agree to give you such security that may be
required as per rules, whenever called upon to do so. I/We shall abide by the rules & regulations prescribed by MERC
& the Electricity Act 2003 and amendments therein from time to time.

1. Applicant’s Name Mr. /Mrs./Ms.

(IN BLOCK LETTERS)
First Name Middle Name

Surname
Occupation/
Designation
Address at which Supply is required
(Please provide complete details)
Plot/Flat No/survey No
House No/Building Name

Lane /Street
Landmark/.

Village/City Pin code

E-mail

Phone No. Mobile No.:

Bank
Account No.(optional)
Bank Name /
Branch (optional)

Existing/Nearest Consumer No.

Type of premises (Tick as applicable)

Owned Rented Lease Others (Specify)

In case of premises on Rent or Lease or not owned by applicant

Name of
the Owner
(Please provide complete details)
Plot/Flat.No./Survey
Building Name
Lane /Street

Land mark Phone No.

Village /City Pin code

2. The following are my requirements (Please tick appropriate box):

2.1 Purpose

Industrial (Type of industry) ________________ Others (Specify)

2.2 Details of the Apparatus No. of Points Wattage of each point Voltage Total Wattage
a) Bulbs
b) CFLs
c) Tube lights
d) Fans
e) Geysers
f) Ovens / Microwave
g) Air Conditioners/
Chillers
h) Refrigerator
i) Television
j) Plug - 5 AMP
- 15 AMP
- 30 AMP
k) Lift
l) Water Pump
m) Motors/ Machine**
n) Others*

Total No. of Points Total Wattage Contract Demand

Total KW KVA
*(In case of any other apparatus attach a separate sheet with specific Wattage.)
** List of machineries should be attached sepreately.

2.3 The wiring/ installation, carried out, is certified by the following Licensed Electrical Contractor
Existing Load/Contract Demand: ___________ KVA/KW/ HP
Additional/ Reduction Load/ Contract Demand: ___________ KVA/KW/ HP
Total Load/ Contract Demand: _____________ KVA/KW/ HP

3. The wiring, carried out, is certified by the following Licensed Electrical Contractor
Name
Address
Rubber Stamp
Tel. No.
E-mail
License No. Valid up to
4.0 List of document/NOC/clearances attached .(Please bring originals for verification)

1. A – 1 form 9. Manufacturer’s test certificate of equipment.

2. Clearance / NOC from MIDC, Local authority.
3. NOC / Consent of MPCB.
4. NOC from Environment Dept. GoM.
5. Power of Attorney by way of a Resolution
Passed by the Board of Directors.
6. Proof of ownership.
7. Copy of last bill paid (For load extension/
Reduction/ Change of Contract Demand)
8. X, Y, Z or W forms (duly filled) along with
affidavit of Z or W form on Rs. 100 stamp
paper. (for change of name)
10. Test report of Electrical Contractor.
11. Permission of Electrical Inspector, GoM.
12. Authorization for signing documents on behalf of the
company.
13. Any other documents / Certificates as directed by Chief
Engineer
14. Clearance/ NOC from Concerned Authority (Saw Mill –
Forest dept., Stone Crusher – Non Agricultural Dept., etc)
according to purpose of Supply.
15. If belongs to SC/ST category, certificate of Authority for the
same

I/we make the following declaration;

a) to abide by the provisions of the Electricity Act 2003 and Maharashtra Electricity Regulatory Commission Electricity
Supply Code and other conditions of Supply.
b) to pay for the supply of electricity based on the prevailing tariff rates of MSEDCL
c) to pay for all other proper charges as become due in accordance with above regulation and approved schedule of
charges of MSEDCL.
d) to deposit such security as MSEDCL may be entitled to be required from me/us under the above Act and
Regulations.
e) to undertake to avail supply within one month from the date the MSEDCL intimate that it is ready to supply to our
premises failing which I/we undertake to pay the MSEDCL the minimum charges as may be applicable.
f) The above information is true and if any false information is observed, I will be fully responsible for the same.
g) In the event of death of individual I/We hereby nominate to receive or adjust the deposit outstanding in my/ our
name to
Shri/Smt/_______________________________________________________________________________________________________

Date:

Place:

* Applicant’s Signature/ Thumb Impression

* In case of thumb impression the same shall be witnessed by MSEDCL Consumer (consumer no. to be specified)/
Notary /Gazette Officer.

Instruction for filling the form:

1. Kindly fill complete and correct information in relevant column.
2. Applicant will be solely responsible for incomplete or incorrect information.
3. Test report should be submitted with complete information related to Load/ Machinery (i.e. Name of MFG, KW
rating, Voltage, etc.)
4. For Change of Name, applicant is requested to fill prescribed X, Y, Z or W forms alongwith ownership/
transfer deed proof or NOC from owner/ legal heirs. In case of residential consumers, simplified form for
change of name will be accepted.
5. All completely filled forms should be submitted in triplicate with required documents to the concerned office
in case of three phase connections. For single phase connection only single copy of A – 1 form will be
accepted.
6. Applicant is requested to take Acknowledgement for form submission.
7. Connection will be released only after payment of arrears (if any) on the said premises.
8. L.T. single phase applications will be accepted at Section Office/ Sub-Division Office/ Consumer Facility
Centre.
9. For L.T. three phase upto 20 KW load, applications need to be submitted at Sub-Division Office and for above
20 KW Division Office will accept the form.
10. H.T. application will be accepted at Circle office/ Consumer Facility Centre.

Acknowledgement

Application No.: Date of receipt: Purpose of Supply:

Name of Consumer:
Address:

(Signature with Office seal)

For Office Use (to be submitted to IT for Billing)

Billing Unit Code :

Consumer’s Static Billing Details (B11)

|---------1-3----------|-----------------------------------------4-15-------------------------------------------------------------| 16 | 25 |-----26-27----|----28 -29----|----30-31-----|----32-33------| 34 | 35 |
B 1 1
|-----------------Consumer Number-----------------------------------------------------------------| PC | | U/R | Dist code | Rev. Cat. |Tariff Code |Duty code | DI |IndCat |

|------------------51-56-------------------------| 57 |----58-59----|----------60-63------------------|------------64-67---------------| 69 73 |--------------------75-80-------------------------|

8 1
|---------- Sanctioned Load----------------- | EI |----MRCY----| --------- Route No ------|----- Sequence No ---------- | | -------------- Batch Number --------------- |

U/R: Fill in ‘0’ if urban , ‘1’ if rural

Revenue Category -Tariff Code-Duty Code-Industrial Category to be fed for the respective MERC tariff.
DI : Disconnection indicator (refer to the table of discon.indicator codes from billing manual)
EI : Employee Indicator ( If the consumer is an employee of MSEDCL fill in ‘1’ otherwise zero ).
IndCat : Industrial Category (refer to table of Industrial Category codes from billing manual)

Sr MERC Category Revenue Tariff code Duty Code Industrial *LOAD

No Category Cols. 30-31 Cols. 32-33 category In HP/KW
Cols. 28-29 ** Col. 35 Cols. 51-56
1 Residential/BPL (LT-I) 11 01 01 Fill in KW
2 Commercial (Non Residential) (LT-II) 21 04 07 Fill in KW
3 PWW (LT III) (Urban) 71 08 49 Fill in HP
PWW (LT III) (Rural) 71 09 49 Fill in HP
4 Agriculture( LT-IV) 61 09 49 Fill in HP
5 Poultry L&F (Agri. LT-IV) 14 12 10 Fill in KW
6 Poultry Motive Power (Agri. LT-IV) 14 11 10 Fill in HP
7 Industry (LT-V) 31 08 10 Fill in HP
8 PowerLoom (LT-V) 31 10 10 Fill in HP
PowerLoom (LT-V) (Commercial) 31 06 10 Fill in HP
9 Street Light (LT-VI) Muncipal Corp. 13 03 49 A Fill in KW
10 Street Light (LT-VI) Gramapanchayat ,A B C 13 03 49 C Fill in KW
Class Muncipal Council
11 Temporary Religious (LT-VII TSR) 21 02 07 6 Fill in KW
12 Temporary Other (LT- VII TSO) 21 02 07 C Fill in KW
13 Advertisement & Hoarding (LT-VIII) 21 05 07 Fill in KW
14 Crematorium& Burial Grounds (LT-IX) 21 02 07 A Fill in KW

* Load in KW feed with one decimal Load in HP feed with two decimal
eg. feed 1.5 KW as follows, e.g. feed 15 HP as follows,

0 0 0 0 1 5 0 0 1 5 0 0

** Feed Duty code ‘49’ instead of the Duty code given in the above table, if the consumer has been exempted from electricity duty.
For Office Use (to be submitted to IT for Billing after release of connection)

Billing Unit code:

Format B34/B25: Consumer’s Supply and Meter Details.

SUPPLY DETAILS (B34)

|---------1-3----------|-----------------------------------------4-15-------------------------------------------------------------| 16 |-------------------17-22---------------------------|--------------------23-28 ------------------------|
B 3 4
|------------------Consumer Number---------------------------------------- ------------------------| PC |------Installation number---------------------| Agreement guarantee expiry date |

|-------------------37- 42-----------------------| ------------------- 43-48-------------------------|---------------------49-55---------------------------------|

|-------Supply Date-------------------------- |------------------Pole No-------------------------|----------------DTC Code---------------------------------|

|-------------------------------66-73----------------------------| |--------------------75-80-----------------------|

|-------------------Old Consumer No------------------------| |------------------Batch Number--------------|

METER DETAILS (B25)

|---------1-3----------|-----------------------------------------4-15-------------------------------------------------------------| 16 |-----17-18-----|----------------------------------19-26 -----------------------------|-----27-28----| 29 | 30 |
B 2 5
|-------------------------Consumer Number--------------------------------- ------------------------| PC |-Meter ID ---|--------------Meter Serial No-------------------------------------|Meter Brand | MO | MD |

31 | 32 |------------------------33-38---------------------|---------------------------------------39-48--------------------------------------------|-------------------------49-54---------------------|----55-56-----|

MP | Amp |--------------Installation Date-----------------|--------------------------------Laboratory No---------------------------------------|-------------Testing Date------------------------|-----M F-------|

|---------------------69-74--------------------|------------------75-80--------------------------|

|----Estimated Avg Consumption-------|-------------Batch Number--------------------|

Meter ID (17-18) MP: Meter Phase codes(31) Amp: Amperage (32) MO: Meter Owner(29)
Residential 90 Single Phase—1 Upto 2.5 Amp – 1 MSEDCL – 0
Commercial 80 Three Phase 3 wire –3 5 Amp – 2 Consumer – 1
Industrial 60 Three Phase 4 wire – 4 10 Amp – 3 CT meter –2
Agriculture 70 20 Amp –5 Static Meter -6, Static electronic--7

MD : Fill in Meter Digits, MF : Fill in Multiplying Factor