ELEC

GOVERNMENT OF GOA

ELECTRICITY DEPARTMENT

(Form of requisition for Supply of Energy Under the Electricity Act, 2003)

To,

The Executive Engineer (Electrical)/Assistant Engineer (Electrical)/Officer-in-charge/Sub-Section. Electricity

Department, Government of Goa,
Division/Sub Division,
................................................................, GOA

Sir,

This requisition is for a new service/a sub service from an existing service ( the name, address &
installation number of the consumer whose service is to be tapped is to be stated here below)/an extension to my
existing installation from /a re-connection/ a change of category of installation number ...................................

I/We hereby request you, to give supply in accordance to Section '43' of the Electricity Act 2003 within
one month or within such period as may be specified by the Appropriate Commission to the premises
owned/occupied by me/us & situated within the area of supply under your jurisdiction.

I/We further require you to supply me/us with the necessary meter(s) on hire in terms of Section '55' of
the Electricity Act 2003, and I/We agree to give you such security as may be required for the price of the meter(s),
and for supply of electricity as under Section '47' of the Electricity Act 2003, whenever called upon to do so.

The details are as stated here below:--

1) Applicant's name/Address. (In Block Letters): ................................................................

......................................................................................................................................

........................................................................................................................................

2) Applicant's Telephone No..................................... Mobile no.........................................

3) email address: ......................................

1. Status of the applicant with respect to the premises

[i.e. Owner/Occupier/Authorized Person/Director]:

2. Description of the premises/firm:

No./Name .............................................................................................................................
Street ........................ Town/Village.................... Taluka.......................District.................
Name & Present Address of the Owner [if the premises belongs to another person]:
.........................................................................................................................................................
................................................................. .......................................................................................
4) The purpose of electricity (Domestic/Commercial/Agriculture/Industrial/Public Water Works/Ice
Plant/IT): For ................................................................... use
5) The following are my/our requirements.

Type of Load No. of points Load in Total

Watts/HP/KVA Wattage/HP/KVA

Light
Fans
Air conditioner
Heating appliances
Plug point 5 amps
Plug point 15 amps
Industrial power/motor/apparatus 1

Others
Total
 6) Total connected/additional load applied for (in Watts/KVA/H.P). -------------------
7) Level of supply voltage (low voltage/11KV/33KV/110KV/_____KV:---------------
8) The system of wiring will be :................................................................................
9) The wiring work will be carried out by:
Wiring Contractor's License No.:
Name:
Address:
Yours faithfully,

(Applicant's dated signature)

Name of applicant:
Date: The ………….. day of ………………… 200………..

NOTES:
1) The applicant is requested to fill in the blanks, strike out the clauses which are not
applicable & attach relevant documents.
2) The Electricity Department shall not be bound to comply with any such requisition under
Section '43' of the Electricity Act, 2003 unless & until the applicant abides by the terms
stated here below:
(a) Within fifteen days after service of a notice in writing in this behalf on him by the
Electricity Department, tenders to the Electricity Department a written contract in the
form approved by the Government of Goa, duly executed and binding himself to take
the supply of energy for not less than 2 years along with sufficient security of such
an amount as determined by the Electricity Department on the basis of regulations in
force and guarantee reasonable return to the Government at current rates charged by
the Electricity Department.
(b) If required by the Electricity Department so to do, pays to the Electricity Department
the cost of any service line as may be laid down or placed for the purposes of the
supply upon the property in respect of which the requisition is made, and of so much
of any service line as it may be necessary for the said purposes to lay down or place
beyond 30 meters from the Department's distributing mains, although not on that
property; and.
3) In lieu of the contract referred to in Note 2(a) above, the Department is prepared to
accept a declaration in the following from subject to deposit of any required security by
the applicable:-
Declaration

I/We hereby declare that l/We desire to have and agree with the Electricity Department to take
supply of energy for the purposes mentioned in the requisition for a for a period of not less than two
years from the date of commencement of the supply as determined by the Electricity Department
and to be bound to the provisions of the Electricity Act, 2003 and to pay the Electricity
Department's charges, appropriate tariffs applicable to me/us and Conditions of Supply as are from
time to time in force.

Affix here
One Rupee
fifty paise
self adhesive
stamp
Applicant's Signature