Date

5-laLFkku dh igpku ds izek.k ds lkFk lkFk

gLrk{kjdrkZ ds i{k esa izkf/kdj.k uohu la;kstu
vkosnu eSuqvy dh rkfydk ds vuqlkj layXu nLrkost
fy[ksa laLFkkvksa gsrq ykxw
5- Proof of identity of Organization along with authorization in
favor of signatory (specify document attached as application of
organization

6
6

7
7

8
8

9
9

1
0

fuosnu dzREQUEST NO

iz.kZrk izek.k i=
completion Certificate

gk
W
Yes
gk
W
Yes
gk
W
Yes
gk
W
Yes
gk
W
Yes

ugha
No

y-u
NA

ugha
No

y-u
NA

ugha
No

y-u
NA

ugha
No

y-u
NA

ugha
No

y-u
NA

chMhvks ls vkokl dk izek.k i=

Certificate of Residence from BDO

gk
W
Yes

ugha
No

y-u
NA

fodkl vk;qDr @chMhvks dk izek.k&i=

NOC from Development Commissioner/BDO

gk
W
Yes

ugha
No

y-u
NA

rstckt+kjh jlhn
Tehbazaari Receipt

gk
W
Yes

ugha
No

y-u
NA

,pvkj foHkkx ls vkxs ds izkf/kdj.k ds lkFk daiuh

ysVjiSM ij i=
Letter
on
Company
Letterhead
with
furtherauthorization from HR Dept
uxjfuxe@HkwLokeh ,tsalh ls[kksdk@vLFkkbZ <kaps
ds fy, vukifRr izek.k&i=
NOC for khoka/temporary structure from Nagar
Nigam/land owning agency
kiFk&i= 1 ds lkFk iw.kZrk izek.k&i= gsrq vkosnu
Affidavit 1 with Application for Completion
Certificate

gk
W
Yes

ugha
No

y-u
NA

gk
W
Yes

ugha
No

y-u
NA

gk
W
Yes

ugha
No

y-u
NA

kiFk i= 2 ds lkFk okLrqfon~ dk izek.k&i=

Affidavit 2 with Architects Certificate

gk
W
Yes

ugha
No

y-u
NA

,lihMh Bsdsnkj dks pwdrk fodkl kqYdksa dh jlhn dh

izfr dsoy ,lihMh {ks=ksa gsrq
Copy of receipt of Development Charges paid is SPD
Contractor (only for SPD Areas)
fiNys pwdrk fcy dh jlhn dh izfr
Copy of receipt of last paid bill

gk
W
Yes

ugha
No

y-u
NA

gk
W
Yes

ugha
No

y-u
NA

fuekZ.k gsrq dkuwuh vuqHkoh ;k Hkwfe@ifjlj ds

oS/kkfud LokfeRo dk izek.k
Proof of lawful ownership of land/ premises or legal
permission for construction
dk;Z djus dh vuqHkoh
Permission to conduct event.

gk
W
Yes

ugha
No

y-u
NA

gk
W
Yes

ugha
No

y-u
NA

32

LFkkuh; izkf/kd`fr dh Lohd`fr@vuqefr ] ;fn fdlh dkuwu

ds varxZr vko;d gks
Approval/permission of the local authority If required
under any law
Hkkxhnkjh QeZ dh nkk esa] Hkkxhnkjh lafonk
In case of a partnership firm, partnership deed

gk
W
Yes

ugha
No

y-u
NA

33

gk
W
Yes

ugha
No

y-u
NA

m|ksx dh nkk esa m|ksx foHkkx ds lkFk iathdj.k ds

izek.k i= dh izfr
In case of Industries , copy of certificate of
registration with Industries department.
iSu dkSMZ mPPnkc la;kstu dh nkk eas vfuok;Z
PAN Card (necessary in case of HT connection)

gk
W
Yes

ugha
No

y-u
NA

gk
W
Yes

ugha
No

y-u
NA

miHkksDrk }kjk LFkkfir tsusVlZ ds fooj.k ds lkFk

tsusVlZ LFkkfir gsrq l{ke izkf/kd`fr }kjk tkjh lsVh
Dyh;jsal izek.k&i= dh izfr;kW
Details of generators , If any , installed by the
consumer along with copies of the safety clearance
certificate issued by the competent authority for
installation of the generators.

gk
W
Yes

ugha
No

y-u
NA

vfiz lqj{kk izek.k i=

Fire safety certificate
oS/k vkS|ksfxd vuqKfIr
Fire safety certificate
xzkeh.k {ks= esa m|ksxks gsrq izek.k&i=
Certificate for Industries in rural areas
fyV lqj{kk izek.k&i=
Lift Safety Certificate

10

1
1
11

1
2
12

1
3
13

1
4
14

1
5
15

1
6
16

1
7
17

1
8
18

1
9
19

2
0
20

2
1
21

2
2
22

2
3
23

2
4
24

2
5
25

2
6
26

fnu
akd

fn

fn

.
dk;kZy; iz;ksx gsrq@For Office
Use only

izfrfuf/k ds gLrk{kj
Signature of Representative__________________________
in@ Designation __________________________________

miHkksDrk izkfIr
jlhn@

uke ifjofrZr gsrq & lHkh ekeys @For Name change- All cases :
2
7
27

2
8
28

uke ifjorZu gsrq kiFk i= ifjljksa rFkk ifjljksa o Lokfe;ksa ij

cdk;k ds ckjs esa opu i=
Affidavit for name change (Undertaking of dues on
premises and ownership of premises)
LokfeRo dk izek.k uksVSjh ifCyd ;k jktif=r vf/kdkjh }kjk
lR;kfir o igpku dk izek.k i= Lo&izekf.kr
Ownership proof (Attested from Notary Public or Gazetted
Officer) & ID Proof (Self Attested)

gk
W
Yes

ug
ha
No

y-u
NA

gk
W
Yes

ug
ha
No

y-u
NA

uke ifjorZu dkuwuh mrjkf/kdkjh@For Name Change

(Legal Heir)
e`R;q izek.k i= vkSj olh;r dh izfr vko;d e`R;q dh nkk esa

Death Certificate and will copy required (In case of death)

29
iqjkus miHkksDrk }kjk vukifRr izek.k i= i;fn thfor gks
3
NOC by old consumer (if live)

2
9

gk
W
Yes

ug
ha
No

y-u
NA

gk
W
Yes

ug
ha
No

y-u
NA

gk
W
Yes

ug
ha
No

y-u
NA

30

3
9
31

vU; dkuwuh mRrjkf/kdkfj;ksa dk vukifRr izek.k&i= ;fn

gks
NOC of other Legal Heir (if any)

uke ifjorZu fcdzh@[kjhn % @For Name Change

(Sale/Purchase Case)

3
2
3
3

gk
W
Yes

ug
ha
No

y-u
NA

tekur jkfk ds cdk;k vkSj vrj.k ds lacas/k esa vuqca/k ] ftl ij

u, o iqjkus miHkksDrk ds gLrk{kj gks
Agreement regarding dues and transfer of security amount
duty signed by new and old consumer

gk
W
Yes

ug
ha
No

y-u
NA

mPpnkc miHkksDrkvksa gsrq@For HT Consumers

gk
ug
IykaV@dk;kZy; ds izLrkfor LFky ,oa izLrkfor fo|qr iznk; ds
3
W
ha
fcanq dks nKkZrk gqvk uDkk ] uDks dk uki mPp nkc
Yes
No
4
la;kstu gsrq lkekU;r% 1 ls-eh- = 1200 ls-eh- ds vuqikr ls
34

3
5
35

3
6
36

vU; Lokfe;ksa dk vukifRr izek.k&i= ;fn ,dkf/kd LokfeRo

gks
NOC of other occupant (In case Multiple ownership)

3
7
37

gksuk pkfg,A
A Map indicating there in the proposed location of the
plant/office and the point where supply is required.The
map should normally be scale of 1cm representing 1200
cm
;fn vko;d gks rks oS/kkfud vf/kdkjh ls yk;lsal@vukifRr
izek.k&i= ;k vkosnd dk ?kksk.kk i= fd mlds fo|qr la;kstu9
ds fy, fdlh izdkj dh oS/kkfud vuqHkoh dh vko;drk ugah
gSA
Licence/NOC from statuary authority , If required or a
declaration by the applicant that his connection does not
fail under the required by NOC under any statue
vkosnd ;fn Lo;a laLFkk ds fy, fo|qr la;kstu pkgrk gS rks ,d
kiFk i= ftlesa mYysf[kr gks fd og ml laLFkk dk Lo;a Lokeh
gSA
In case of propriety firm , an affidavit to be submitted
stating that the applicant is the sole proprieter of the firm.
vkS|ksfxd la;kstu gsrq mRiknu@mRiknu esa c<+ksrjh ds
fy, ysVj vkWQ baVsV
Letter of in intent for production/enhancement in
production may be furnished

y-u
NA

gk
W
Yes

ug
ha
No

y-u
NA

gk
W
Yes

ug
ha
No

y-u
NA

gk
W
Yes

ug
ha
No

y-u
NA

3
83
8

3
93

izLrkfor midj.kksa dh vuqekfur Hkkj lfgr lwph

List of equipments proposed to be installed along with the
expected load

gk
W
Yes

ug
ha
No

y-u
NA

izkf/kd`r gLrk{kjdrkZ ds fy, izLrkoResolution for authorised signatory.

gk
W
Yes

ug
ha
No

y-u
NA

m|ksx foHkkx ls iathdj.k

Registration from industries department.

gk
W
Yes

ug
ha
No

y-u
NA

izkWtsDV fjiksVZ dk og Hkkx] tks m|ksx vko;drkvksa rFkk

mRiknu dh izfdz;k ls lacaf/kr gks m|ksxks ds izdj.k esa
Extract of project report relevant to power and process
requirements (in case of industries.

gk
W
Yes

ug
ha
No

y-u
NA

4
04
0

4
14
0

vkosnd@izkf/kd`r gLrk{kjdrkZ ds gLrk{kj

Signature of Applicant/Authorized Singnatory........................
(Office Only)

dk;kZy; iz;skx gsrq

fnu
akd
Date
uke/Name

fn
D

f e e o o
n
D M M Y Y

_________________________

deZpkjh vkbZMh@Employee ID
__________________________

fuosnu dzREQUEST NO

.
dk;kZy; iz;ksx gsrq@For Office
Use only
dk;kZy; iz;skx gsrq (Office Only)

fnua
kd
Date

fn
D

f
n
D

fuEukafdr fo|qr la;kstu pkfg,@CONNECTION

SERVICES(S) REQUIRED :

uohu fo+|qr la;kstu

fo|eku fo|qr

la;kstu
NEW CONNECTION
LFkk;h fo|qr la;kstu

EXISTING CONNECTION

fcuk ehVj ls ehVj

okyk
PERMANENT CONNECTION
UNMETERED TO METERED
vLFkkbZ nh?kZdkyhu
iqu
% fo|qr l;kstu fudzh; TEMPORARY (LONG TERM)

fnua
kd
Date

RECONNECTION (DORMANT)

vLFkkbZ vYidkyhu
TEMPORARY (SHORT TERM)

,Llsy fo|qr forj.k lkxj

izk-fyESSEL VIDYUT VITARAN (SAGAR) PVT. LTD.

ekWx
Demand
fuEunkc I/T
mPp nkc HT

fn
D

f
n
D