Format-XI

BANGALORE ELECTRICITYSUPPLY COMPANY LIMITED

(Wholly owned Government of Karnataka Undertaking)

APPLICATION FOR SURRENDER OF RR NUMBER

(Except IP set installations under LTCategory)
UNDER CLAUSE34.02 OF KERCCONDITIONSOF SUPPLY

1 NjTrrrrij"rl 11111111111111111111111111111

Address of the installation

House No./Flat No./Shop No./Plot No. I I I I I I I I I I I I I I I I I I I

Floor Street Name

Areal Location Cross
Main City
Pin I
Ph. No. Mobile
Landmark
Email

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I I I I I I I I I I I I I I II I I I I I I I II I I II I I I I I
Existing Contract Demand/
Sanctioned Load

Existing Tariff

Reason for surrendering of

installation

Address: Signature of the consumer

Name:
Date:

Version-I

J
 GENERAL INSTRUCTIONS

1. Application should be filled up in Block letters only

2. The filled up application hasto be handed over to the concerned AEE

3. The Registered Consumer has to give an undertaking to the Licenseein a prescribed format to
effect surrender of power supply

4. For any clarifications please contact concerned Sub Division office

For any Electricity Complaints/ Suggestionspleasecall BESCOMHelpline 1912

Visit: www.bescom.org

•
 INDEMNITY BOND ANNEX -10

(In case of surrenderof Installation)

'I, the undersigned, the registered Consumer of the installation bearing RRNo write to
undertake on this day month year with the Asst. Executive Engineer
(Elec.), ESCOM......................................................................... . .
............................................ ... that I have applied for surrender of the said installation
permanently. At a later date, if any arrears are found due to audit short claims, etc., I am
prepared to pay the amount in lump sum or the same can also be included in the bills of the
other installation bearing RR No.---- which is standing in my name. If I fail to pay the
demanded amount, legal action as necessarymay be taken against me and also Power Supply
to installation bearing RRNo. may be disconnected.

Signature

Witnesswith address