SCHEDULE- I

Annexure II
DISCONNECTION/ REOPENING FORM
(Tripura Jal Board)

Application Form for Disconnection/ Reopening

Name of Applicant: -

KNO: -

Reason for Disconnection/ Reopening: -

Contact Details: -

Documents to be attached: -

Photocopy of proof identity: -

Photocopy of the last bill paid: -

I hereby declare that all the information furnished by me is true to the

best of my knowledge and if any discrepancies are found, I will be
responsible for disconnection of services by the TJB without any prior
notice and any other legal action taken by TJB.

□ I Agree
Signature of Applicant

Details of Applicant:
KNO: This is the consumer number. It is compulsory.
Application for Disconnection /Reopening:
Please fill Disconnection or Reopening. It is compulsory.
Reason for Disconnection /Reopening:
Please fill the reason for Disconnection or Reopening. It is compulsory.
Contact Details:
Mobile Number: It is compulsory to provide a mobile number, as it will be used for sending
SMS alerts.
Documents to be attached: It is compulsory.
Photocopy of Last Paid Bill: Attach a photocopy of the last paid bill and provide the
document number.

To
The Assistant Engineer
DWS Sub-Division No.-I/II/III/IV
Collegetilla/Milansangha/Kunjaban/Jogendranagar
Agartala, West Tripura