FORM 16.

THIS FORM IS NOT CHARGEABLE

(ALL INFORMATION TO BE FILLED IN BLOCK LETTERES.PLEASE TICK WHEREVER APPLICABLE)

NEW CONNECTION CONTRACT DEMAND CHANGE LOAD CHANGE

SHIFTING CHANGE OF NAME CHANGEOVER SUPPLY

SWITCH OVER OF SUPPLY

Note:Please do not staple the
photograph

1. Customer Details
Applicant's Name Mr. VIPUL LAXMICHAND VEERA
(New Name in the event of Change
Of Name)

Existing Account No 102075633 Mob No. 8779522650

Landline No Email veeravipul3167@gmail.com

AADHAR No 874549114310 PAN

GSTN (As per Rule 114B of Income Tax Rules 1962) Refer point 19 from declaration cum
undertaking
(AS per Rule 49 of GST Rules,2017)Refer point 19 from
declaration cum underatking

Bank Name

Bank Branch.
Bank Account Number

2. Customer Power Supply Address

Flat No./Building Name 402 HAJI BAPU RD MALAD E
Lane/Street

Landmark BEHIND AMBAJI TEMPLE

Suburb/City MUMBAI Pin code 400097

Area of premise Sq.mtr.

Existing/Nearest Consumer Account Number 102075633 Meter 8322945

Structure type

Chawl Hut Bungalows Multistoried Bldg. Others(Specify) Flat in registered society

3. Bill Delivery/Correspondence Address

Same as Power Supply Address (In the event of bill Delivery Address diffrent than Power Supply Address)

Flat No/Building Name

Lane/Street

Landmark

Suburb/City Pin code

Preferred Bill Language is Marathi Hindi English

I want my electricity bill E-Bill + Hard Copy Paperless

4. Types of premises

Owned Rented Lease Others(Specify) Flat in registered society

5. Purpose of Supply: (In the event of New Connection)

Residential Commercial Temp-Religious Temp-Others Contsruction Power

Others(Specify)

Peroid of Temp Connection (Max. 1 Year): From : To :

Industrial certificate valid till :

6 Load/Contract Demand (In the event of New Connection,Extention/Reduction of Load Contract Demand)
 Particular Existing Required
kW HP kW HP
New Load
Change of Load
Contract demand in kVA(Non-Residentail Load > 20kW)

Number of meters (In case of building application) Single Phase:- 0 Three Phase :- 0

7. The wiring carried out/certified by the following Licensed Electrical Contractor

Name
Address
Telephone Number
E-mail
Licence No

8. Changeover of Supply
Meter Number The Meter will be provided by AEML Self

9. Documents Attached
A. Identity Proof submitted along with this application form :-
> if applicant is a person
>If applicant is an organization (mention Applicable)-Certificate of incorporation/registration issued by the Registrar
B. Proof of ownership or occupancy of premises for which electricity connection is required_____________________

THE APPLICANT HEREBY AGREES AND UNDERTAKES

1. That the Applicant/Consumer is not a minor.
.......................................................................................................
2. That in case the applicant is not the sole owner of the premises,
no objection certificate has been obtained from the co-owner.
.......................................................................................................
3. To abide by the provisions of the Electricity Act,2003, all
applicable laws, conditions of Supply/Tariff Orders and any other
Rules or Regulations as may be notified by the
Commission/Authority, as applicable from time to time.
.......................................................................................................
4. That AEML shall be at liberty to adjust the electricity
consumption charges due/outstanding along with any other
charges against the Consumer Security Deposit paid by the
Applicant upon permanent disconnection of supply.
.......................................................................................................
5. To indemnify AEML against all proceedings, claims, demands,
costs, damages, expenses that AEML may incur by reason of a
fresh electricity connection given to the Applicant.
.......................................................................................................
6. That to the best of applicant’s knowledge, all electrical works
done within the premises are as per Central Electricity Authority
(Measures relating to Safety and Electricity Supply) Regulations,
2010 as amended from time to time.
.......................................................................................................
7. That the internal wiring at the premises has been tested by a
Licensed Electrical Contractor having valid license
issued by Licensing Authority, Government of Maharashtra and the test
certificate is available with the Applicant and can be produced as may
be required at any later stage.
.......................................................................................................
8. That the Premises/building/structure has been constructed as per
prevalent building Bye- Laws and the total height of the
Premises/building/structure-
(i) does not exceed 15 (fifteen) metres on the date of seeking
electricity connection, or
.......................................................................................................
(ii) is more than 15 (fifteen) metres and has obtained valid Clearance
certificate from appropriate government authority, which is available
with the Applicant.
.......................................................................................................
9. That there is a provision of lift in the Premises and the Applicant has
obtained the valid lift fitness certificate from the Electrical Inspector for
the lift in the said Premises and the same is available with the
Applicant and can be produced as may be required at any later stage.
.......................................................................................................
10. That the Applicant would let the Distribution Licensee disconnect
the electric connection under reference, in the event of any default,
non-compliance of statutory provisions and in the event of a legally
binding directive by Statutory Authority(ies) to effect such an order.
This shall be without prejudice to any other rights of the licensee
including that of getting its payment as on the date of disconnection.

Name & Applicant's Signature Date 31/Jan/2022

 11. That if the premises applied for is falling under CRZ,Forest
area or any other area where any Court of Law/Statutory Authority
has prohibited release of power supply, the Applicant shall submit
a No Objection Certificate (NoC) to seek electricity connection,
from such Authority.
.......................................................................................................
12. That the applicant is solely and exclusively responsible for the
genuineness and correctness of the document/s submitted by him
in support of the application and the other documents as indicated
at various points herein. In case any such documents are found to
be fraudulent and/or fake and/or forged and/or incorrect and/or
invalid/incomplete, then the applicant/consumer shall be solely and
exclusively responsible for the criminal proceedings and/or any
court proceedings initiated and/or any dispute which arises any
time in future and AEML and/or its successors, assignees and/or
any employee thereof, shall not be responsible for the same in any
manner whatsoever. In such a case, AEML reserves the right to
disconnect the connection granted and in case of Change of
Name, re-transfer connection in the name of previous registered
consumer under this declaration cum undertaking, without any
notice.
.......................................................................................................
13. That all details mentioned in the application form are correct
and all applicable customer-end obligations (E.g. Documentary and
Payment compliance, Site readiness,Way-Leave permits) are
complete and complied in all respects, at the time of applying for
new electricity connection, through online/offline mode. In case any
of these requirements are not ready, or in case of an
objection,AEML reserves the right to cancel the application.
.......................................................................................................
14. That the Applicant will provide a copy of any of above
applicable documents to the Distribution Licensee pursuant to the
request from any external Government agency, judicial forum or
any other authority empowered under statute seeking such
information.
.......................................................................................................
15. That Applicant’s industry/trade has not been declared to be
releasing obnoxious hazardous/pollutant by any Government
agency and that no orders of any court or judicial authority would
be breached by running of Applicant’s industry/trade or granting
any electricity connection to the same. The Applicant shall
indemnify and keep indemnified AEML against any loss of any
nature on this account.
.......................................................................................................
16. The Applicant further agrees to indemnify and hold harmless,
AEML and/or its successors and/or its employees, in case of any
injury or incident on account of any fault in electrical works in the
Premises and from point of supply to the Premises. AEML shall not
be held responsible/liable for any mishap or incident occurring at
the Premises or from point of supply to the Premises on account of
any faulty/defective/inferior quality wiring/installation, right from the
time of energizing the new electricity connection.On occurrence of
such incident, AEML may disconnect the Applicant’s supply, if
continuance of supply to such installation is threat to the life or
property. Such disconnected supply shall be reconnected only after
rectification of faulty installation and submission of test report from
Licensed Electrical Contractor.
.......................................................................................................
17. The applicant further agrees to bear the expenses towards
repairing/ replacement of AEML’s assets or works, in case there is
sufficient proof that the damage/fault has been occurred due to
faulty electrical work/ wiring in his premises.
.......................................................................................................
18. To pay the electricity consumption bills and all other charges, at
the rates set out in the licensee’s Tariff Schedule and the MERC
approved Schedule of Charges,
Name & Applicant's Signature
as may be in force from time to time, regularly, as and when the same
becomes due for payment.
19. To deposit the additional security deposit (as applicable) from time
to time, based on the prevailing Orders/rules, directions and
Regulations of the Commission.
.......................................................................................................
20. For GSTIN :In compliance of Rule 49 of CGST Rules,2017, I/We
shall forthwith submit with AEML my/our Goods and Service Tax
Identification Number or Unique Identity No. a Bill of supply (monthly
electricity bill ) shall print Goods and Services Tax Identification
Number or Unique Identity Number, if registered, of the consumer
For PAN :
i.)As per Rule 114B of Income Tax Rules 1962 every person is
required to quote his PAN in all documents pertaining to the transaction
of sale or purchase of any nature for a value exceeding Rs. 2 lacs per
transaction for the purpose of clause (c) of sub-section (5) of Section
139A
.......................................................................................................
ii.)As per section - 206AA of Income-tax Act, 1961, TDS (if
applicable)@20% on Security Deposit Interest will be deducted instead
of 10% for non-availability of valid PAN
.......................................................................................................
21. Applicable only for applied Industrial/Commercial oad between 100
and 150 kW: The Applicant authorizes AEML to debit the approved
connection charges and applicable security deposit in first electricity bill
(as and when enabled by AEML), and undertake to pay the same
within the due date. The Applicant / Consumer may opt to pay such
Security Deposit by way of a Bank Guarantee.
.......................................................................................................
22. That the Applicant shall not hold AEML liable for delay in providing
connection or meeting any Standards of Performance subsequent to
grant of connection in case AEML is prevented from doing so on
account of any force majeure events/exemptions as specified in the
Standards of Performance Regulations, as amended from time to time.
.......................................................................................................
23. That there are no arrears towards energy or related charges
outstanding in his/her name and /or on account of the said premises. In
the event of aforesaid declaration/undertaking given by the
applicant/consumer is found false in view of any pre-existing liability,
the applicant/consumer shall willfully, without demur pay such amount
on demand. The Consumer/applicant shall be duty bound to extend full
co-operation to AEML while determining and/or identifying the arrears,
if any, of the premises or account no, within a period of 60 days. The
applicant/consumer shall make payment of the said arrears
immediately on demand.
.......................................................................................................
24. The Applicant/Consumer shall identify suitable space agreeable to
AEML to install electrical meter and related devices and ensure un-
hindered passage to personnel of AEML to access the meter cabin.
.......................................................................................................
25. That the following terms and conditions are complied with respect
to space for meter installation:
a. Metering installation is protected from excessive dust and moisture,
exposure to direct sunlight, rain and water seepage and vermin. The
Applicant/Consumer shall ensure that temperature within the meter
room shall not be more than 10°C, above ambient. It should not be in
proximity of machineries, heating devices,equipment generating high
vibration or magnetic fields and areas prone to fire and toxic hazards.
Date 31-Jan-2022
 b. Meters are not located at an elevated area or a depressed area
that does not have access by means of a stairway of normal rise. The
meters shall not be installed below/in the stair case or in common
passage or lobby.
.......................................................................................................
c. Board wiring is carried out preferably on Fire retardant plywood,
complying IS 5509. In case of nonavailability of FR plywood, marine
plywood complying IS 710 can be used. The plywood shall be of 19
mm thickness and the same shall be provided by an applicant.
Typically plywood is available in following sizes (7’x4’ , 7’x3’,
8’x3’,8’x4’ ).IS mark is printed on the center of either face of the ply
for identification.
.......................................................................................................
26. That the following terms and conditions shall be complied with, for
applicant/consumer’s installation beyond the point of supply of AEML:
a. The Applicant/Consumer must install appropriately rate MCB with
enclosure near the start of the electricity supply and shall not install
DP Switch.
.......................................................................................................
b. The Applicant/Consumer, if having voltage exceeding 250 Volts,
shall provide his own earthing system for installation.
.......................................................................................................
c. The Applicant/Consumer, if having sanctioned load above 2 KW,
shall install Earth Leakage protective device
.......................................................................................................
27. The applicant/consumer shall provide way leave in favour of
AEML:
i.) to lay its cables through his/owner’s land/ property
.......................................................................................................
ii.) to access AEML’s equipment and work in its premises in
accordance with the applicable provisions of Supply Code or any
other Regulations, as prevailing from time to time
.......................................................................................................
iii.) to provide permanent Right of Way to AEML personnel along with
vehicles and cables and/or apparatus, without any further consent (for
now and in future)
.......................................................................................................
iv.) for laying, strengthening and maintaining of electrical network and
system
I/We declare and undertake that I/we have complied with all statutory requirements under all Statutes for the time being in force.
I/we shall be solely responsible for any issue arising out of any such non-compliance and further I/we do hereby jointly and severally Indemnify
AEML, its agents and servants against all claims, proceedings, demands, costs, expenses and consequences whatsoever, which may arise on
account of processing my/our application.
Applicatn's Signature
Date 31-Jan-2022
Business Partner Number
For Office Use
Application processed by
v.) for laying outgoing feeders (LT/ HT) from their premises as the
same arrangement is for making interconnection with outside network
which shall further help in arranging alternate supply in case of break
down on mains. In the event land under way leave permission is sold,
leased, rented or otherwise disposed off, while entering to such a
transaction the applicant/consumer shall ensure by necessary
covenants that this terms and conditions will be abided by the other
parties to the said transaction.
.......................................................................................................
28. That the excavated trenches shall be reinstated by the
Applicant/Consumer at his/her own cost when the cable is laid to
provide supply to their premises. AEML shall be responsible to
reinstate in the event the works is carried out to provide supply to any
other customer.
.......................................................................................................
29. That AEML shall have full rights to optimally utilize its assets
(Substation/ pillars) in applicant/consumer’s premises and shall not
object to laying outgoing feeders (LT/ HT) from their premises as the
same arrangement is for making interconnection with outside network
which shall further help in arranging alternate supply in case of break
down on mains.
.......................................................................................................
30. Additional Term and Conditions for Change-over applications:
a. The consumer/applicant shall clear all it's dues with existing
distribution licensee and submit the proof.
.......................................................................................................
b. Changeover is permissible to existing consumer where name and
purpose or classification of category for which the electricity has been
provided by previous distribution licensee remains same.
.......................................................................................................
c. The meter reading for final billing shall be taken jointly and signed
off by both distribution licensees in presence of the applicant/ it's
representative.
.......................................................................................................
d. In the event the consumer/applicant is not present at the time of
final meter reading, the readings taken jointly by the previous
distribution licensee and AEML shall be final and binding upon the
applicant / consumer. The Final meter reading shall be the opening
meter reading for AEML.
(Signed by Second Party where the account is to be
in joint names)
Place
Account No