HPSEBL Form CS-1 (b)

HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED

(A STATE GOVERNMENT UNDERTAKING)
Application and Agreement Form for other than Domestic Electricity Connection.

Application No. Connection No. Date of Receipt Signature of HPSEBL Official

(Note:- The applicant should hand over this A&A form to local office of HPSEBL in the area in which the
supply is required along-with a non-judicial stamp paper of Rs. 10/- dully crosses with words “Agreement for
supply of Electricity/Power” on stamp paper)
The Assistant Engineer/Assistant Executive Engineer/Executive Engineer,
Electrical Sub- Division, HPSEBL Limited,
________________
Sub:- Application and agreement for new connection/revision of load or CD/change of name
for other than domestic electric connection.
A) Particulars of Applicant/Consumer & premises

i) Name of applicant/Company/Firm/Establishment……....................................
ii) Name of authorized signatory/Proprietor/firm/Partner …………………………………..
iii) S/o, D/o, W/o..........................................age...........
iv) PAN No. …………………………………… Aadhar No(optional)…………………………………
v) Mobile No.__________________ Tel. No………………………………………..
vi) Email………………………………………………………………….
vii) Number of shifts ……………………………………
viii) The wiring work will be/has been carried out by (Name of licensed
contractor/wireman)............................................................
Full Address of Premises where connection is required:
House /Plot No. Village /Town/City
Floor No District
Landmark Pin Code
Sector/Colony/Street Whether MC/NP/TCP
area (Y/N)
Description of premises [ No of rooms,
floors, other area where supply of to be
given]
B) Details of load/class of application etc.
i) Schedule of energy consuming apparatus to be connected:
Description Lamps, Tubes etc. Fans Heaters and Motors
of Refrigerators etc.
apparatus
No. Total No. Total No. h. p. each Total KW
Wattage

Wattage

kW kW
1-Ø 3-Ø 1-Ø 3-Ø

1 2 3 4 5 6 7 8 9 10 11 12

Total

[In case of Extension in load, the existing & additional Load is to be indicated separately]

ii) Total Connected load(kW) of above installation (4+7+11+12).......................... kilowatts

Existing ……………………………(kW) Addl./New……………………(kW).
iii) Total Contract demand(kVA) of above installation[ Mandatory for all Single Part Tariff as
well as two part Tariff]………………………………………………(kVA)
Existing Contract Demand…………….(kVA) + Addl Contract Demand………………..(kVA)

iv) Voltage at which supply would be preferred........................kV

v) Purpose for which connection is required……………………………..
(NDNC/Commercial/SIP/LIPS/MIP/IDWPS/BS/SLS/TMS/RT)
vi) Details of other connections existing in the name of the applicant
a) Account No. ……………………………….b) Cust.ID………………………………………….
c) Category of supply…………………………………….…………………………………..……
P.T.O.
 [2]-CS-1(b)
vii) PAC details[ applicable only in case the new/additional Contract demand is more than 100
kVA]
Letter No…………………….. dated ………………………… Load (kW)……………..
Contract Demand(kVA)…………………………………………………………………….
viii) Class of Application:
(a) A new connection: ............................................
(b) An extension to my/our existing installation (connection A/C No. ………………..)
(c) A re-connection (the previous consumers' name is .............................................
and his connection A/c No. is .................................................)
(d) A change of name/title from Shri..................................Connection A/C
No..........................
(e) Change of Supply voltage for existing connection A/C
No……………………………………….
(f) Other(please mention)…………………………………………………………
ix) Approximate date from which connection is required........................................
C) Deceleration/ Undertaking
I/We ……………………………………….. Son /Daughter of ………………………………………. Resident of
……………………………………( hereinafter referred to as “Applicant”, which terms shall mean and include executors,
administrators, heirs, successors and assigns), do hereby swear and declare as under:-
Or
The ________________________, a company incorporated under the provisions of the Companies Act,1956 or
as amended, having its registered office at _____________( hereinafter referred to as “Applicant”, which
expression shall, unless repugnant to the context or meaning thereof, include its successors and assigns),
through its Authorised representative Mr………………………………………………….., do hereby swear and declare as
under:
Or
A sole proprietorship/ a partnership firm having its office at……………………………….( hereinafter referred to as the
“applicant” which unless the context otherwise provides includes its successors and assigns), through
Mr…………………………, who is a partner or an authorized representative do hereby swear and declare as under:-
i) That the Applicant is a lawful owner/occupant of premises ……………………………………mentioned at Sl. No. A(viii)
above ( hereinafter referred to as “Premises”), in support of which the applicant(s) has enclosed proof of
ownership/ occupancy and has request the Himachal Pradesh State Electricity Board Ltd. (HPSEB Ltd.)
(hereinafter referred to as “The Licensee”) to provide an electricity service connection at the above mentioned
premises in the Applicant’s name for the purpose mentioned in the Application and Agreement Form and the
applicant agrees to take supply of electricity for the aforementioned purpose only.
ii) That the internal installation at the premises has been tested by a Licensed Electrical Contractor.
iii) That there is a provision of lift in the premises and the applicant has obtained the lift fitness certificate from the
concerned authority for the lift in the said premises and the same is available with the applicant.$
iv) That I/We request the Himachal Pradesh State Electricity Board Ltd. (HPSEB Ltd.) (hereinafter referred to as
“The Licensee”) to provide an electricity service connection at the above mentioned premises in the Applicant’s
name for the purpose mentioned in the Application and Agreement Form and the applicant agrees to take supply
of electricity for the aforementioned purpose only.
v) That the applicant has applied for the correct category of tariff as per the applicable tariff schedule. For either of
the following categories of connection, the applicant has the relevant documents available with him:-
a) Industrial : Valid Industrial License/ Factory License in case of rural village.
b) Agriculture Consumers: Certificate of Residence from the concerned authority.
vi) That I/We hereby agree to take supply from the licensee at the premises stated above, a supply of electrical
energy not exceeding the connected load & contract demand of mine/our installation as noted above and I/We
hereby further agrees to pay the electricity consumption bills and all other charges at the rates set out in the
licensee’s Tariff Schedule and miscellaneous charges for supply as may be in force from time to time , regularly
as and when the same becomes due for payment and I/We further agrees to deposit security and additional
security as per HPERC (Security Deposit) Regulations, 2005 & HPERC(Recovery of Expenditure for Supply of
Electricity), Regulations 2012, as amended from time to time and any other charges which may become due
from time to time
vii) That licensee shall be at liberty to adjust the electricity consumption charges due/ outstanding along with any
other charges against the consumers Security Deposit paid by the Applicant, in the event of termination of
agreement prior to expiry of the contracted period of in case of any contractual default as per provisions of
regulations/rules/orders/directions of the Commission.
viii) That I /we shall abide by the provisions of Electricity Act, 2003 all applicable laws, conditions Supply , orders,
Directives, Notifications issued and enforced under applicable laws by HPERC/CEA/Govt. of India/Govt. of HP and
any other instructions/circulars issued by HPSEB Ltd. from time to time and as amended from time to time, for
equitable and efficient distribution of electric energy, which has been perused by me. These are also available on
website of HPSEBL and HPERC i.e. www.hpseb.com & www.hperc.org.
ix) That the Applicant hereby agree that he/she shall accept any restrictions imposed by the Licensee in order to
comply with the regulations made by the Authority under section 53 of the Electricity Act 2003 and any terms
restricting the liability of the Licensee for economic loss resulting from negligence of the consumer, as per clause
3.7.1 of the Electricity Supply Code 2009 and its amendments by HPERC from time to time.
x) That to the best of my/our 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.
I/we hereby agree that I/We shall abide by CEA(Measures related to Safety and electrical Supply)
Regulations,2010 & its amendments, HPSEBL Electrical Safety Manual and General Safety Instructions, Electricity
Rules under Electrical Act & its amendments, CEA( Safety Requirements for Construction, Operation and
Maintenance of Electrical Plants and Electrical Lines) Regualtions,2011.
 [3]-CS-1(b)
xi) I/We hereby agree that I/We shall abide by the power cut restrictions/peak load hours restrictions.
xii) That monthly average power factor of installation in the above mentioned premises shall not be less that 0.9,
failing which we shall be liable for payment of power factor surcharge and other penalty as per Tariff
Order/Supply Code.
xiii) That I/we undertake to build up the load to the extent of load sanctioned/sanctioned Contract demand within
period of two months from the date of readiness of HPSEB Ltd. failing which I/We shall pay charges as per
Himachal Pradesh Electricity Supply Code,2009 and its amendments issued from time to time.
xiv) That I/We would let the licensee disconnect the service connection under reference, in the event of any default,
non-compliance of statutory provisions and in the event of a legally binding directive by the 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.
xv) That I/we shall be solely held responsible for contravention, if any, of Act/ Law of any statutory authority/
Central/ State Government Department and HPSEBL shall not be made party on any omission/ contravention by
me/us. Any loss on this account shall be my/ our liability.
xvi) That I/We agrees to indemnify and hold harmless, the licensee, in case of any injury or incident on account of
any fault in electrical work in the premises. The licensee shall not be liable for any mishap or incident occurring
at the premises to the applicant and the works maintained by applicant , on account of any fault/
defective/inferior quality of wiring at the premises for which the connection is being applied.
xvii) That as per HP Electricity Supply Code,2009 as amended from time to time , I shall provide suitable and
adequate space for installation of the meter/ electrical equipments where the licensee may have ready access to
the same.
xviii) That I/We undertake to indemnify the licensee against any loss accrued to the Licensee if the
declaration/undertaking furnished by me/us prove to be false/incorrect or are unfulfilled. I/We further undertake
to indemnify the licensee of any harm/loss to the Licensee’s property for any loss/harm to any third party on
account of any fault in the electric work at my /our premises. Further, applicant agrees that if there is any
harm/loss to the property of the Licensee, due to the fault of the electrical network within the premises of the
Applicant, all the liabilities shall have to be borne by the applicant.
xix) That the Licensee shall have the right to supply electricity to other consumers from the service line or
apparatus installed on my/our premises as per Supply Code/HPERC Regulations.
xx) That my 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 my
industry/trade or granting any electricity connection to the same. The licensee is indemnified against any loss
accrued by the applicant on this account.
xxi) That grant of the applied electricity connection will not confer any legal right for regularization of building/land
use in respect to the electricity connection provided at the Applicant’s premises. Further, it shall also not confer
any right in favour of Applicant to have permanent electricity connection.
xxii) That the applicant would allow clear and unencumbered access to all authorized officials of the Licensee to the
premises of the Applicant for the purpose of meter reading, maintenance, inspection, checking, testing etc.
xxiii) That I/We indemnify the licensee against all proceedings, claims, demands, costs, damages, expenses that the
licensee may incur by reason of a service connection given to the Applicant as per Class of Application at Sl. No.
B(viii).
xxiv) That I/We have complied with all requirements under all statute for the time being in force and the Applicant
himself/herself shall be held legally responsible for any issue arising out of any such noncompliance for which the
licensee may initiate action in accordance with applicable law.
xxv) That I/We have clearly understood that if the above statements/information prove to be false or incorrect or on
receipt of a reference from concerned statutory authority/ law enforcing agency regarding
sealing/demolition/vacation of the premises the electricity connection can be disconnected and the meter
/service line can be removed by HPSEB Ltd. without any further notice to me.

This agreement for the Electricity connection shall be effective from the date the connection is
released and shall remain effective till such time as it is either replaced by fresh agreement or it is terminated
as per provisions of H.P. Electricity Supply Code.

Date: - - /- -/- - - -/ Signature of Applicant

21
Signature of Witness
Name of witness............................A/c No..............................
Address of Witness .............................................................
…………………………………………………………………………………………………
Signature on behalf of HPSEBL
Name & Designation………………………………………………………………………….
(To be signed by load sanctioning authority)
$: Strike through if not applicable
Note: The consumer who intends to apply for Net Metering , the application shall be made on Form-1 and
agreement shall be executed on Form-2 of HPERC(Rooftop Solar PV Grid Interactive Systems based
on Net Metering)Regulations,2012. The agreement executed on Form-2 shall be supplementary to the
agreement on A& A form.

P.T.O.
 [4]-CS-1(b)
(FOR OFFICE USE ONLY)- Other than Domestic Connection
Name of Consumer:
1. a) Standard Supply Voltage .............................. Volts b) Availed Supply Voltage…………..
c) Metering Voltage……………………………………………….
2. Name of Feeding Sub-Station………………………………………..
3. Category applicable as per Tariff Order..............................
4. Details of Amount deposited by the applicant:-
a) Security deposit
Sr. Amount Receipt No. Dated Purpose[New load/addl.
No. CD/Load/revision of security
based on average tariff]
i)
ii)
iii)
b) Normative IDC
Sr. Amount Receipt No. Dated Purpose[New load/addl.
No. CD/Load/revision of security
based on average tariff]
i)
ii)
iii)
c) Cost of Service line/Estimate i) Amount(Rs)…………ii) Receipt No. ……………. Dt…………….
Sr. Amount Receipt No. Dated Purpose[New load/addl.
No. CD/Load/revision of security
based on average tariff]
i)
ii)
iii)

[5]-CS-1(b)

5. Accepted/Sanctioned/ Recommended[ Please Tick ] Signatures……………….

Comments/recommendations Designation AAE/AE/AEE
 Dated:……………………….

6. Sanctioned /Recommended[ Please Tick ] Signatures…………………

Comments/recommendations/ Sanctioned feeding arrangement Designation :Sr.EE/ASE
 Dated:………………………

7. Sanctioned Signatures……………….
Feeding arrangement sanctioned Designation SE/Dy.CE
 Dated:…………………….
 Checklist for Other than Domestic Consumers/Applicants[CS-1(b)]

Sr. Description Please

No. Tick 
A) General
i) Application and Agreement Form (A&A Form) duly completed and signed by the applicant.
ii) Test Report duly filled and signed by licensed Electrical Contractor.

iii) Crossed Non-Judicial Stamp paper of Rs.10/- attached with A&A form

iv) Valid Power Availability Certificate issued by HPSEBL (in case contract demand for new and
additional load of more than 100 kVA)
v) Approval of Chief Electrical Inspector in case of HT/EHT installation energisation.
vi) Brief Project report [In case of industrial connection]

vii) Process Flow[In case of industrial connection]

viii) Copy of Certificate of registration in case of Companies/Firms etc.

ix) Undertaking on Annexure-A on Plain paper (where “NOC is not available with consumer)
(For Temporary Connection under TMS Category of Tariff)
B) Identity/Ownership
i) Identity Proof ( any one of the documents given below)

PAN

Adhaar Card

Driving License

Passport

Voter ID Card

ii) Proof of Ownership/Occupancy( any one of the following)

Revenue Papers for Land/Building/premises

Sale Deed

Lease Deed

Any other proof of ownership/occupancy given by Statutory Authority.

C) Authorized Signatory [In case of Companies only]
Resolution of Board of Directors for authorized signatory on behalf of company

D) Charges to be deposited [Ref. HPERC Regulations 419/2012, HPERC Security Deposit

Regulations, 2005] and their amendments from time to time.

i) Initial Security

ii) Normative IDC*

iii) Cost of Service Line or Departmental Charges as the case may be.

* Those consumers who are covered under Regulation-6, 5(3) & 5(9) of HPERC(Recovery of
Expenditure for supply of Electricity),Regulations,2012 as amended from time to time shall
have to bear the cost accordingly.

………………………………………………………………………………………………Cut here…………………………………………………………………………………………………………………..
ACKNOWLEDGEMENT
HPSEB Ltd.
Date Name of Applicant Tariff Category Application No. Load(kW)

(Signature of Authorized person of HPSEBL)

 Annexure-A
UNDERTAKING /Declaration ( where “NOC is not available with consumer)

I/We ……………………………………….. Son /Daughter of ………………………………………. Resident of

……………………………………( hereinafter referred to as “Applicant”, which terms shall mean and
include executors, administrators, heirs, successors and assigns), do hereby swear and declare as
under:-
Or
The ……………………………………………, a company incorporated under the provisions of the
Companies Act,…….. or as amended, having its registered office at …………………………………….(
hereinafter referred to as “Applicant”, which expression shall, unless repugnant to the context or
meaning thereof, include its successors and assigns), through its Authorised representative
Mr………………………………………………….., do hereby swear and declare as under:
Or
A sole proprietorship/ a partnership firm having its office at…………………………………………………….(
hereinafter referred to as the “applicant” which unless the context otherwise provides includes its
successors and assigns), through Mr…………………………, who is a partner or an authorized
representative do hereby swear and declare as under:

THAT the Applicant is a lawful owner/occupant of premises at …… ……………………………………(

hereinafter referred to as “Premises”).

THAT the Applicant has requested the Himachal Pradesh State Electricity Board Ltd. (HPSEB Ltd.)
(hereinafter referred to as “ The Licensee”) to provide an electricity service connection at the
above mentioned premises in the Applicant’s name for the purpose mentioned in the Application
and Agreement Form and the applicant is unable to produce No Objection Certificate( NOC) for
electrical connection from [Name of respective concerned Authority]....................

THAT I, the Applicant hereby agree and undertake/declare:

1) that the licensee may disconnect the electricity connection , in the event of a
legally binding order issued by the Statutory Authority(ies) for disconnection of
supply owing to any default /non –compliance of the statutory provisions;

2) that such connection released under temporary metered supply category, on the
basis of this undertaking /deceleration shall be regularized, in the respective
category , only after submission of either floor wise or entire building completion
plan sanction letter issued by the concerned Statutory Authority(ies). This shall be
without prejudice to any other rights of HPSEBL, including of getting its payment
due as on the date of disconnection.
THAT in furnishing the present undertaking/ declaration, the Applicant has clearly understood that
if any of the statements in this undertaking/ deceleration proves to be false or incorrect at any
later stage, the licensee shall be within his lawful rights to disconnect supply to the premises
without any prior notice and proceed to adjust electricity supply dues payable by the applicant
against consumer security deposit and /or recover the same in accordance with Law.

THAT I, Applicant shall be held responsible, if the contents of the undertaking/deceleration are
proved false at any stage and I/We indemnify HPSEBL of any consequences arising out of release
of electrical connection to my premises.

Applicant
SELF VERIFICATION:

I/We, the above named Applicant(s) do hereby verify that the content of undertaking/deceleration
are true to the best of my knowledge and nothing material has been concealed therefrom.
Verified on …………………..

Applicant
 HPSEBL Form CS-10( Page-1)
HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED
(A STATE GOVERNMENT UNDERTAKING)
WIRING CONTRACTOR'S TEST REPORT
AND
HPSEBL'S INSTALLATION TEST ORDER
Name and Address of Premises where connection is required:
Name of Applicant ………………………Address…………………………………………………Description
of Premises………………………………………………………………………………………………………………..
From (Wiring Contractor)
Name and Address:……………………………………………………………………..
……………………………………………………………………………………………….
License No…………....... Dated --/--/---- Valid up to --/--/----.
To
The AE/AEE/EE/ ESD, HPSEBL ………………….
REPORT

We hereby inform that Electrical Installation at the premises belonging to the

above consumer, as detailed on page 2(backside) is now ready for your engineer to test and
connect up with your mains. The installation was tested by me/us on.......................................
(date) and the insulation resistance was as shown at page 2.

Dated:_ _/_ _/_ _ _ _/ Wiring Contractor's signature..............................

HPSEBL’S INSTALLATION TEST ORDER

(A)
The Junior Engineer/ Addl. A.E, Electrical Section, HPSEBL_______________

Please test the installation detailed on pages 2, fill in columns 18 to 22 and report as
below. It may, however, be ensured that the intimation regarding the date on which you intend to visit the
consumer’s premises for the above said purpose is given to the consumer or his representative well in
advance, so as to enable him to be present at the time of Inspection. Also please ensure that for any
subsequent visit for testing of the said installation necessitated by the consumer on the previous visit or due
to defective installation, the consumer is asked to pay the requisite charges as per the schedule of general &
service charges and receipt No./date vide which the charges are paid by him is quoted in the report.

Assistant Engineer /Assistant Executive Engineer

Dated ………………………….
(B) REPORT
(1) Above installation was tested by me on (date)…………………………..in the presence of consumer (or
his representative) and the insulation Results were as shown on page 2. The following defects were
found in the installation.
i) Whether Insulation Resistance Satisfactory…………………………………

ii) Other Defects, if any (a)…………………………………………………….

(b)……………………………………………………
(c)……………………………………………………
(2) (a) The above installation was tested by me on my first visit.
OR
(b) The installation was tested by me on my subsequent visit for which the consumer
deposited the amount of Rs…………………….as per the schedule of general & service
charges vide Receipt No……………………….Date………………

Signature of Consumer
Name( in case of representative): ………………
Dated:_ _/_ _/_ _ _ _/ Signature
Junior Engineer/Addl. A.E.
Dated:_ _/_ _/_ _ _ _/
P.T.O.
 SCHEDULE OF ENERGY CONSUMING APPARATUS TO BE CONNECTED HPSEBL Form CS-10( Page-2)
Description Lamps / Fans, Heaters, Motors INSULATION RESISTANCE [MEGA-OHMS]

Earth Resistance(in Ohms)]In case of Medium, HT&EHT

Tubes Etc. Cookers,
Refrigerators etc.
No. of Circuits (left to Right) on Distribution Board

No. Total No. Watts Total No. h.p/ Total kW Wiring Contractor’s HPSEBL Test
kW each kW kW each Test

Total connected load of each circuit (in kW)

1-Ø 3-Ø 1-Ø 3-Ø

Conductors

Conductors
& earth

& earth
Between

Between
Conductors

Between

Between
Conductors
lamp or apparatus

lamp or apparatus

lamp or apparatus

lamp or apparatus

lamp or apparatus

lamp or apparatus
After connecting any

After connecting any

Before connecting any

Before connecting any

Before connecting any

Before connecting any

Size of Conductor

installations
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
No.1

No.2

No.3
No.4

No.5

And so
on ……..

Load verified for …………………..(kW) The Size of connecting wires

Between Meter Board & Dated Signatures of the
Dated Signature of Verifying Officer/Official Distribution Boards …………… .Wiring Contractor ………………..
Name & Designation of Verifying Officer/Official……………….
………………………………………………………………………….