Peuur PUNJAB STATE POWER CORPORATION LIMITED "APPLICATION AND AGREEMENT (A &A) FORM m (LT Supe) (TO BE COMPLETED AND SIGNED BY APPLICANT) Rae of i pct onion? sends pnt bestia ae a) Aachar Cord No. ress roto be sbrid) 2) Howe Premesis No. SucetNo 2) Area / Colony ‘MEERA KOT NEAR INDRA PROCESSORS @_Giy/ Vilage TINALA ROAD AMRITSAR. ©) Telephone No Mile No Traoanas 2) Enal Adis [-_[esegory Purpose oF apply cs ‘Schedule comming pps tz Category Description No. [WAS Total kW | p> akon ‘Accor 40 Wats is bcd Fan Pos eter Wats (oe ir be ceumed) fy Wal soca SBS (DS Pupose) esr Wats ut coe) [Power Pigs cel 1 Wan uh Be suet ACs healer 200 Wat lb coe) ID Otier/Mosve nis po Liek Pons Aca 0 Wate (ib nee) Fan Poin eer Wats be noe) NAS nda BS (URS Indi Se a dw be oe) puspotes)/APHghTech Power lags cao 10 Wats hao bec) lacs ‘Aspect peal cote) I) Tusa Movive / thr loads “oul Connected Land EW) [5 [toad Demand Appliod GWAVA) 5195 f)_Fxisng oad demand any O70 by Account No. ey Adina iad demand requied 70 [Toul oud demand 95.195 [@_[Permanent Apion No 7 Fy [rocessing fc reczipt no. and date [Secu (eonsumption receipt no and ate fy [Security (meter reeipt no. and date Scanned with CamScannerTo) ype of pply Permanent Terponn) PERMANENT] J) Type of sructur Permanent / Tempera) [PERMANENT] 5 enpweary supply pif eid Ty inate if weeks are wo be eae ety you Torte senze connection NO, 12 fndicateifyou weet instal your own meer ofthe approved make N 3) [any eee des oustanding in PSPCL are f supply in consume? rae NO. ta) Thay elec due oustanding forthe premises or which connection / ada oad pps for NO. 5) Pty Sic does ousting of PSPCL again any fn company wit which te consumer & NO fssocited ac an Over, Pane, Director or Managing Director 7 a separate sheet) (Note: (For questions 13, 14 and 15 the answer I ‘Yes In any case please provide etal 16) VWe declare on oath that 2) WWeanvare maior 1) We arare the lawful ower ofthe premises or myloulowner of the premises agrees to my/our taking the said supply and histheir writen is anached herewith ‘We are the awl occupier ofthe premises but tas nt been posible for meh to obtain consent from the owner of the premises and UWe hereby agre to keep the PSPCL inderified and harass against ll claims made and action and proceedings taken up by the owner ofthe premises or any person claiming through or undr him by reason of| Biving of tis electric conection bythe PSPCL to mols. ©) We hereby agree that UWe shal abide by the power cut estcionsfpeak lod hours restrictions. There i no other electri connection runing the above premises. (One No, DSINRS electric connection i lreay existing in the shove premises and I/We want to take second ‘connection fr which LWe are ready to comply withthe conditions of the PSPCL. ©) Lama Schaduled CastSTIBC/BPL for which copy of relevant cxtfiats is atached. underakng/nsirvtons or any other information i found tobe flea any stage, my/our electric connection may on a ra ee acer eee cease ge amen 270, we Partner “Signature of the applicants) 17) We hereby request Punjab State Power Corporation Limited (herin-afler referred to asthe PSPCL) to give supply for Toad demand mentioned in r.No.S above. UWe hereby further agree to pay forthe sui supply in accordance with the ‘elevant Schedule of Tarif 3s approved by the Commission from tie to time and also to pay all such other charges as may become due from mel, /We sso agree to abide by the provisions of Supply Code-2014, General Conditions of “Tal axff Schedule axiff Orders and Elecicty Act-2003 as amended from time ote. {We farther request yu to supply metus withthe necessary meterimetring equipment. We agree to deposit security (one ee cr py PRINTS Dj 9 =e 07] c ——— n im ar Tu PODB (Siguuure of ad sanctioning authority) (Signa of ofoafical veitving he with designation ‘correc of he application) (Gor and om behalf ofthe PSPCL) Name Designation. Die Scanned with CamScanner