From To The Assistant Engineer/O&M Tamil Nadu Electricity Board, Chennai. Sir, Sub: Electricity- Name transfer of LT service connection No. Distribution Tariff Requested-Regarding. Thiru. Son of aged years, and residing at Full address & Phone No. The premises bearing Door No. Name of Street Village / Town Taluk with Service connection No. Tariff Distribution in the name of Son aw is in my possession. ‘The Municipal Tax for the above property is given in my name and Xerox copy of the receipt duly attested by Gazetted Officer is enclosed. (or) Metro Water / Sewage connection is given in my name and the Xerox copy of the same duly attested by Gazetted Officer is enclosed. Application and Agreement Form. Indemnity Bond on Rs.80/- Non Judicial Stamp paper. T request that the name of Service No. may kindly be changed to my name. Yours faithfully, xName Transfer Forms (Refer to Regulation 5(7) To The Asst. Engineer, O&M, CEDC / South Sir, L S/o, Djo, W/o. owner of premises bearing No hereby give me consent for the transfer of service bearing A/c No. standing in my name / in the name of to Thiru / Tmt S/o, Djo, W/o. since I had Sold / settled / partitioned / my house to him / her. The transfer may be effected with available deposit/ subject to condition that the transferee pays the security deposit and other charges. Signature of Transferor Place : Name :UNDERTAKING WHEREAS | / We $/0, D/o, Wlo. hereinafter called Consumer have approached the Electricity Board hereinafter referred to as Board for transfer of Account No. for supply at in my / our name and whereas the Board after perusal of documents produced by me/us has agreed to effect transfer of Account, as sought for by the Consumer this undertaking witnesses the following : 1 The Consumer shall pay on demand and without demand all dues to the Board including such dues as may become payable as a result of reversion of Bills relating to the period prior to the transfer of A/c. in his / her / their name(s). The commitment to pay the demands relating to the period prior to the transfer of account will include such demands omitted to be made periodically and such omission has been detected after the service has been transfered in the name of the consumer. 2. The Consumer agrees that the Board shall have the right to enforce disconnection of supply in the event of consumer failing to fulfill the obligation of this undertaking. 3. The Consumer further agrees to indemnify the Board any any losses/ damage or any other liability, the Board may further as a result of any dispute or disputes raised by the Consumer himself/herself / themselves or by any other party with regard to the transfer to account at any time. Witness with Address Signature of the Consumer x aX 2 2XFORM - 1 TAMIL NADU ELECTRICITY BOARD FORM OF REQUISITION FOR SUPPLY OF LOW TENSION ENERGY (Except Agriculture and Huts) Applicant’s Name Father / Husband Name Address For Office Use esa ame aOR Tre NG) Reg. Fees Receipt No. & Date aa To Regn. No Mere Service / extension The Assistant engineer / Junior Engineer Regn. Date T.N.EB ee es EE (Section office) Sir/Madam 1, request you to supply electrical energy to the premises hereinafter described. 2. Lagree to pay the tariff as notified from time to time for energy supplied through the service connection and other dues including the current consumption and additional current consumption deposit as may be demanded and revised by the Board from time to time. 3. Twill avail supply under (Domestic / pub. Lighting & water Supply / recog. Edu.Instns, etc, / actual places of public worship/cottage & Tiny Industries / Information Technology Industries / commercial). 3 XK 4, T agree to take supply for more than two years and utilize the energy in the premises described hereunder. qs 5. In case, I sell or otherwise dispose of the property / vacate the premises while the supply is continued in my name, I agree to give one calendar month / seven days notice in writing and pay all the arrears to the Board. Failing such notice, I hold myself responsible for all the charges payable in the service including energy ‘consumed in the premises even after my vacation or dispossession. 6. Description of premises Door No Street Town / Village Taluk ‘Owned by (Name in Block letters) Tenanted by (Name in Block letters) 7. The following are my requirement : Lighting number & Wattage Total Points/Wattage Lights Fans Domestic electrical appliance Cookers Water heaters Refrigeration Other Purpose Walls plus 5 amps -do- 15 amps MotorsI declare that -am the legak ‘owner or lawful occupier of the above said premise, ni 9, I declare that there is no disconnected service in my building and no court case is Pending and no objection for the building to get service connection and that the meter board is placed at a convenient height to take meter reading. 10. (A) For mere service connection from overhead lines only I declare that a. My building is within 36.56 meters (120 feet) from nearest TNEB pole. b. The Vertical clearance of the service connection wire is well within the clearance from the ground as per Indian. Electricity act and rules framed there under. (The clearance as of now is ) Service connection wire is with enough way leave or I am enclosing no objection letter from the concerned, if it crosses the other's concerned Building / Land. d. No. L.T. / H.T/ E.H.T line crosses in any way over my building. (B) For service connection involving extension, I agree to pay the different in estimate charges, (©) I hereby undertake to provide space as per Board requirement in our premises if the total floor area is 900 sq. mts. And above for erection of Board equipments. 11. I/we, undertake and certify that all the particulars and information furnished above are true, correct, complete and upto date in all respects to the best of my knowledge and also undertake to indemnify the Tamil Nadu electricity Board against any loss caused to it as a result of effecting electric supply to the said premise on the strength of such particulars and information. I further agree that in case any of the particulars or information furnished above is found to be false at the time of effecting service connection or at a later date, the electric supply to the said premises will be refused/disconnected without any notice to me in addition to launching of civil and criminal proceeding against me/ us and that appropriate damages as fixes by the Tamil Nadu electricity Board from time to time may also be claimed from me / us. 12. I also undertake that I will not tamper with the meter or seal and 1 will not use electricity for purposes other than the purpose for which it was obtained. 13. The writing has been completed by Thiru approved Wiring contractor E.B no. If any theft of energy or violation is noticed in the service connection, I am aware that I am liable for any criminal proceedings, penal levy as decided by Board from time to time in addition to disconnection of service. Date : * ise stialose tires Signature of applicants I certify that the wiring has been carried out and completely by me in all respects according to the rules and specification as provided in the Indian Electricity Rules 1956. I am bound to be penalized if my above certificate is provided false. Approved Wiring Contractor (Signature with seal and address) Date : EB No. Note: precautions to be adopted by consumers, owners, electrical contractors, electrical workmen, licenses and other suppliers of energy No electrical Installation work, including additional, alternations, repairs and adjustments to existing installations except such as replacement of lamps, fan, fuses, switches and other components parts of the installations es inno way alter its capacity or character shail be carried out upon the premises or on behalf of any consumer or owner for the purposes of the supply of energy to such consumer or owner, except by an electrical contractor licensed by state ‘Government. In this behalf and under the direct supervision of a person holding a certificate of competency issued by the state Government,