Application Form for New Connection

Type of Request

Water Connection Water and Sewerage Connection

Sewerage Connection Regularization

Govt. Organization (Please tick if it is a Govt. Organization, provide supporting document)

Contact Details
Email Id: Home Tel. No: Office Details (If DJB Employee) Employee Id: Office Name: Address Line 2: State: Date Of Retirement: Address Line 1: City: Pin Code: Mobile No:* Office No:

Property Address
Pin Code:* Sub locality:* Road No: Sub locality 2: Village: Society Name: Locality:* House No:* Sub locality 1: Sub Colony: Khasra No: JJR Colony

Property Details
Development Charges Paid (Submit Latest Payment Receipts): Property Type:* No. Of Floors:* Area (In Sq m): Plot Area:* Water Connection Type:* Water Connection Use:* Urban No Of Beds:* (For Hospital Only) Built Up Area:*

Water

Sewerage

Other Details
Preferred Mode of Payment:* Preferred Mode Of Communication:* No of Children:

Cash Email And SMS

Cheque Demand Draft Paper Format And SMS

Documents to be attached
Proof of Identity:* Document No:* Property Ownership Document:* Document No:* Proof of Residence:* Document No:*

Driving License PAN Card GPA Govt. Allotment Letter Driving License

Passport Voter ID Card Allotment Letter NOC from Landlord Passport

Ration Card

Sale Deed Conveyance Deed Election Identity Card

Bank Details
Name of the Bank: Name of the Branch: MICR Code: Bank Account No:

Declaration
1. 2. 3. 4. 5. 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 DJB without any prior notice and any other legal action taken by DJB. I declare that there is no dispute on property and there is no stay from any court of law against obtaining water/ sewerage connection. I further undertake that in case of any dispute about the ownership of the property i will absolve DJB from any legal battle in the court of law as the water connection applied for is related to supply of potable water and not to decide the ownership of property. I further undertake to pay the charges as and when demanded by DJB, and in the event of non-payment, DJB will be at liberty to disconnect the services being provided by DJB. I further undertake that I have not taken DJB Employee Rebate against any other Premise/Connection.

I Agree
Date: Place:

_______________________________ Signature Of Applicant:*

Instructions to fill The New Connection Application Type of Request : Select the type of connection request. Details of Applicant: Please tick if it is a Govt. Organization and provide supporting document with the application form. All details must be provided in Block Letters except Email ID. First Name and Last Name: Should be provided. First Name is compulsory. Father/Husband Name: Applicant's father or husband name should be provided and is compulsory. Strike through the one that is not applicable. Example: Father/Husband Name: MR. SUMIT KUMAR DUTTA (If father's name is provided and viceversa.) UID number may be provided but is not compulsory. Contact Details: Email Id: Should be provided in exact case. It is optional. Mobile No: It is compulsory to provide mobile no., as it will be used for sending SMS alerts. Home Tel. No: May be provided to facilitate communication. It is optional. Office No: May be provided to facilitate communication. It is optional. Office Details: Employee ID: The employee ID of the applicant. To be provided by DJB employees only. Date of Retirement: The date of Retirement of the Applicant. To be provided by DJB employees only. Office Name, Address Line 1,Address Line 2, City , State, Pin Code may be provided to facilitate communication but is not compulsory. Property Address: Pin Code: Pin code of the property must be provided. It is compulsory. Locality, Sub locality and House No must be provided correctly. These are compulsory. Road No, Sub locality 1, Sub locality 2, Sub colony, Village, Khasra No, Society Name, JJR colony should be provided. These are optional. Property Details: Development charges Paid: If development charges are paid for either water or sewerage or both, the photocopy of the related receipt must be attached with the application form. Property Type: This may be Tower, Office complex, Mother dairy Booth, Mall/Cineplex, Individual house, Hotel/guest House, Hospital /Nursing home(No. of beds must be provided In this case), Group Housing Society, Govt Flats, Dharmashalas/Hostels, DDA flats, Bungalows, Banquet Hall, Apartment. Any other property type will not be accepted. It is compulsory. Refer to the table Property Type below. Urban: Please tick it if the property is present in an urban area. No. of floors: Must be provided. It is compulsory. No. of beds: Must be provided in case the property type is Hospital/Nursing home. Plot Area: Enter the total plot area. It is compulsory. Built Up Area: It is compulsory to provide the built up area. It must be less than or equal to plot area. Water Connection Type: It is compulsory to provide the Water Connection Type. Valid values are Domestic, Industrial/Commercial, Mixed, Gov/Rain Water Harvesting. Refer to the table Water Connection Type below. Water Connection Use: It is compulsory to provide the connection use. (Example: Delhi Fire Service, Group Housing Society etc.). Refer to the table Water Connection Use below.

Other Details: Preferred mode of payment: Tick the relevant check box to choose the preferred mode of payment. It is a compulsory field. Preferred mode of communication: Tick the relevant check box to choose the preferred mode of communication. It is a compulsory field. If Email and SMS option is selected, then Email Id must be provided in contact details to facilitate communication. No. of Children: Number of children must be provided. It is a compulsory field. No. of Adult: Number of adults must be provided. It is a compulsory field. Documents to be attached:

1. 2. 3.

Proof of Identity Doc: Attach photocopy of any one of the following documents and provide the document number.(Voter ID card, Ration card, PAN card, Driving license, Post card). Property Ownership Document: Attach photocopy of any one of the following documents and provide the document number.(GPA, Allotment Letter, Govt Allotment Letter, Sale deed, NOC from landlord). Proof of Residence: Attach photocopy of any one of the following documents (Driving license, Passport, Election ID card). It is compulsory to provide the document number of the attached documents.

Bank Details Name of the bank: Enter the name of the bank. Name of the branch: Enter the name of the branch of the bank. MICR code: Enter its MICR code. Bank Account Number: Enter the applicants bank account number. All fields listed under bank details are compulsory and must be provided correctly. Declaration: I agree:Tick the I Agree check box to accept the declaration. Signature of the applicant: Put in the signature of the applicant in the box given. This form captures some information (say Billing Address etc.), which may be used by DJB in future. Property Type (Enter any of the below in Property Type ) Tower Office Complex Mother Dairy Booth Mall/Cineplex Individual House Hotel/Guest House Hospital/Nursing Home Group Housing Society Govt Flats Dharmasalas/Hostels DDA Flats Bungalows Banquet Hall Apartment

Water Connection Type (Enter any of the below in Water Connection Type) Mixed Domestic Commercial/Industrial Gov/rain water harvesting

Water Connection Use (Enter any of the below in Water Connection Use) B.S.E. RAJDHANI B.S.E.S. YAMUNA Banquet hall/ Party hall Delhi Jal Board Delhi Metro Rail Corporation Delhi Transco Delhi Transport Corporation Beauty Parlors Blind Schools Bottling Plant C.P.W.D. Cineplex Cold StorageCold Storage Cooling Plant Courts D.S.I.D.C. Delhi Development Authority Delhi Fire Service (Fire Stations) Delhi Govt. Office/Central Govt. Offices Dhobi Ghats Factory Fruit & Vegetables StoreReliance Safal Govt. Hospitals/ Dispensaries Govt. Institute/Collages/ Universities Group Housing Society Hotel & Guest houses Malls Milk Dairy North Delhi Power Ltd. Piaos Police Department Professional Office(CA , Lawyer,Property) Pvt. Hospitals & Nursing Homes Sweet Shop/Tea Stall Vehicle Service Station Ware House/Godown Lab/ X-Ray Units M.C.D. M.C.D. Slums & J.J. Department M.T.N.L. Restaurant/ Dhaba Shops Soda Water Factory Soft Drink Factory

Ice-Cream Factory/Ice Factory Pvt. Institute/Collages/ Universities Janta Flats Jewelery Manufacturing Factory/ Repairing Juice Shop Pvt. Schools Railways Religious Place