TAMIL NADU GENERATION AND DISTRIBUTION CORPORATION LIMITED New Service Application - lerms and Conditions Mame / Appication 200045410822353 FORM Application Form for L1.Service Connection (except Temporary Supply. agriculture and Mut) FORM OF REQUISITION FOR SUPPLY OF LOW TENSION ENERGY(SINGLE PHASETHREE PHASE) [Refer regulation 2703), 10. ‘The Designated Engineer AEJOBMY Thammapacty/-ural usesz421 (Address ofthe licensee) Sin, We Thiru/Tmty Reliance ji infacomm sd S/oD/oW/o Ws,jfo Tower hereby request you to supply electrical energy for the purpose of Telecom Towers. to the premises hereinafter described We agree to pay for said energy, service connection charges, the deposit of such security, meter rent,development chats land any other charges as may be demanded in accordance with the scale of rates prescribed under Tamil Nadu Electric Distribution Code, Supply Code, notifications and orders issued in tis regard by Tamil Nadu Electricity Regulatory Commission, 3./We wish tobe charged under tariff Commercial under schedule ofthe TNERC tariff order in force ‘41 We agree to aval supply and utilize the energy inthe premises described hereunder for my/our bonafide use. 51n case,yWe sell or otherwise dispose of the property / vacate the premises while the supply is continued, I/We agree to gh ine Calendar month notice in writing and pay all the arrears to the Licensee. Falling such notice, IWe hold myselffourselw lable for payment of arrears of current consumption charges.other dues if any and claims that may atise in the event termination of agreement and undertake for loading the dues to other service connection(s) that may stand in my/our name(s). 6. Description ofthe premises a}Door No and/or name of the house or premises : $F.NO.295/1C2 b)Street KONERIPATTI Town/Village and Taluk KONERIPATTI /Ganagaval Owned by (Name in Block Letters): K.PALANIAMMAL cerTenanted by (Name in Block Letters} RELIANCE J1O INFOCOMM LIMITED ‘Applicant(s) address for correspondence: $F.NO.295/1C2,KONERIPATTI,KONERIPATTI,Ganagavalll ‘Contact no and e-mail id: 8098824714,rajeshkumar2.p@rll.com “1 Tne following are my/our requirements f5.No [Pescription [Number of Points [Wattage of Points FTotal wacrage ‘A)_ [Lighting points 1. fughes ° ° 0 2. Fans ° ° ° 3. [convenient wall pugs ° 0 0 192. \Water heaters ° ° ° 3. fretrigerator ° ° ° 4 fiirconditioner 1 1500 7500 5. [uittselevatorscalators ° ° ° 6._ [other Purposes z 7000 2000 7. [convenient wallalugs ° ° o ©) _[Powertoads 1. Pomestie o ° 0 2, [industrial ° ° ° 3. welding ° ° ° 4. [other purposes ° ° ° 5. eonvenient wall plugs ° ° ° Total applied load 35 KW ‘Demand applied for in KW: 3.5 KW ‘S.Whether the installation is provided with earth protective device (RCD)as per TamiNad Electricity Distibtion Code: Yes 10.The wiring has been completed on: 18-08-2022 11.Detalls of existing service connection(s) ofthe applicant(s) if any: 12.Whether any current consumption charges or any other charges are due to TANGEDCO in the name(s) of the applicants) or premises: No PRECAUTION TO BE ADOPTED BY CONSUMERS, OWNERS OCCUPIERS ELECTRICAL CONTRACTORS ELECTRICAL WORKMEN AND SUPPLIERS ‘No electrical installation workincluding adetions.alteraions repairs and adjustments to existing installations except such replaceme of lamps.fansfusesswitches domestic appliances of voltage not exceeding 250 V and fittings as in no way alters its capacity character, shall be carried out upon the premises of or on behalf of ary cansumer,upplie.ewner or occupier for the purpose of supe to such consumer,supplie.owner or occupier except by an electrical contractor licensed jn this beholf by the Stote Government or under the direct superisin of a person holding a certificate of competency and by a person holding a permit issued or recognized 1 the State Government |nwe certify tht we are aware ofthe above precoutian and agree to abide by it. ie agree to pay tothe licensee atthe applicable tarif/minimur ratesfied charges/surcharges etc that may be decided by the 1) Commission from time to tie. Iie agree to abide under all specifcations.cancitions ond provisions laid down in TomiNadu Electricity Regulatory Supe ode, Distribution Code and the applicable Act, Cades, Rules and Regulations ond of ary modification or re-enactment thereof for thet being in force and subject tothe canltion of revisions, amendments approved from time to time. (Wote:This undertaking does not preclude execution of a seperate written contract to be entered with Licensee) Signature ofthe Applicants Name(s) n Block leter: 28TAMIL NADU GENERATION ANO DISTRIBUTION CORPORATION LIMITED [Note:The application shall be accompanied withthe following documents: (Othe self attested copy of proof of ownership such as sale deed (or) partion ded (or gift settlement (orjllotment letter (orcomput. potta(oriownership certificate issued by revenue department oficial (orcourt judgement or recent property tax receipt (Im cose of joint property elf artested copies of proof of ownership olang with parent documents specified in note () above or consent letters from co-ownersif consent letter I not producec.on indemnity band with enhanced security deposits. Ain ifthe applicant isnot the owner consent letter from owner in FORM No.5 or valid proof of accupancy and indemnity bond in FOR Nos. (FOR LICENSEE'S USE ONLY) [ACKNOWLEDGEMENT ‘Applicant's Name:Relance jo Infocomm Ltd ‘Address:SF.NO.295/1C2 KONERIPATTIKONERIPATTL Ganagavall Date of receipt 18-08-2022 Reference No :200045410822353, Category of Supply: Commercial AEIOBMI Trammapatty/rura saaseszaz — Signature and seal of Distribution Licensee (cea) Name and Designatior a