ANNEXURE -I

Format of application form – New Connection

Licensee name M/s….

Photograph
Application No._________________

1. Name of the applicant/organization:

2. Name of
father/husband/director/partner/trustee:

3. Address:

(a) For communication House/plot/premises no.

Street

Area/colony

Pin Code

Telephone No.:

Mobile:

E-mail:

(b) Where supply is required House/plot/premise no.

Street

Area/colony

Pin Code

Telephone No.:

Mobile:

E-mail:

(c) Indicate landmarks (Pole No./Feeder

Pillar No./Nearest House No.) to identify
the location

4. Category for Electricity Usage (i)Domestic Category –

Residential/Hostels/Hospitals*/Educational
(As per applicable Tariff Schedule) institutions*/Religious/charitable/others
(ii)Non domestic-Banks/petrol
pumps/cinemas/shops/chemist/tailors /others

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 (iii) Industrial
(iv)Agricultural/(v)
Mushroom/(vi) Public
Lighting/(vii)DJB/(viii)DIAL/(ix)
Railway Traction/(x) DMRC/(xi)
Advertising/Temporary Supply
Note: the applicant shall refer the applicable tariff schedule for correct tariff category. In
case of any doubt, the applicant shall seek help of the licensee.

*based on the funding pattern as per tariff schedule.

5. PAN No. (For correct deduction of TDS, if

any)

6. Purpose of supply

7. Total load applied for (in kW)/ (in kVA)

8. Please indicate whether you want to

purchase your own CEA approved meter
having additional features as approved
by the Commission (Yes/No)

9. List of documents attached:

(i) Identity proof submitted along with this application form

(ii) Proof of ownership or occupancy of premises for which electricity connection is
required
(iii) If applicant is an organization (tick Certificate of incorporation/registration
applicable) issued by the Registrar

10. Declaration Form

Date: Signature of the applicant/ authorized signatory along with

company seal:

Place: Name:

Declaration

I, ____________________________________ Son/Daughter of _____________________

Resident of _____________________ (hereinafter referred to as “Applicant”, which term shall
mean and include executors, administrators, heirs, successors and assigns), do hereby swear
and declare as under:

Or

The _________________________, a company incorporated under the provisions of the

Companies Act, 1956 or as amended, having its registered office at
________________________________________________________ (hereinafter referred to
as “Applicant”, which expression shall, unless repugnant to the context or meaning thereof,
include its successors and assigns), through its Authorised representative
Mr.___________________, do hereby swear and declare as under:

Or

A Sole proprietorship/ a partnership firm having its office at _____________________________

(hereinafter referred to as the applicant which unless the context otherwise provides includes its
successors and assigns), through Mr.___________________, who is a partner or an authorized
representative do hereby swear and declare as under:

THAT the Applicant is a lawful occupant of the premises at

____________________________________ (hereinafter the “Premises”).

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THAT the Applicant has requested the licensee to provide a service connection at the above-
mentioned premises in the Applicant’s name for the purpose mentioned in the application form.

THAT in furnishing the present Declaration, the Applicant has clearly understood that should any
of the statements in this declaration prove to be false or incorrect at any later stage, the
licensee shall be within his lawful rights to disconnect supply to the premises without any prior
notice and proceed to adjust electricity supply dues payable by the applicant against consumer
security deposit and /or recover the same in accordance with Law.

THAT the Applicant has complied with all requirements under all statute for the time being in
force and the Applicant himself/herself shall be held legally responsible for any issue arising out
of any such noncompliance for which the licensee may initiate action in accordance with
applicable law.

THAT I, the Applicant hereby agrees and undertake:

1. That in case the applicant is not the sole owner of the premises, no objection certificate
for seeking electricity connection from the co-owner has been obtained.
2. To indemnify the licensee against all proceedings, claims, demands, costs, damages,
expenses that the licensee may incur by reason of a fresh service connection given to the
Applicant.
3. That to the best of applicant’s knowledge, all electrical works done within the premises
are as per Central Electricity Authority (Measures relating to Safety and Electricity Supply)
Regulations, 2010 as amended from time to time.

4. That the internal Wiring at the premises has been tested by a Licensed Electrical
Contractor and the test certificate is available with the applicant:

Provided that in case of Government quarters/ offices, the certificate issued by the
designated officer of the Government may be accepted by the distribution licensee.

5. *That the building has been constructed as per prevalent building Bye-Laws and the total
height of the building
(i) does not exceed 15 (fifteen) meters on the date of seeking service connection; Or
(ii) is more than 15 (fifteen) meters and Fire Clearance certificate is available with the
applicant.

6. *That there is a provision of lift in premises and the applicant has obtained the lift fitness
certificate from the Electrical Inspector for the lift in the said premises and the same is
available with the applicant.

7. That the applicant has applied for the correct category of tariff as per the applicable tariff
schedule. For either of the following categories of connection, the applicant has the
relevant documents available with him.

*Applicable for selected consumer category

a. Industrial
Valid Industrial License/Factory License/Lal Dora Certificate in case of rural village

b. Agricultural Consumers
i. Certificate of Residence from Block Development Officer
ii. No Objection Certificate from Development Commissioner/Block Development
Officer Delhi Jal Board for tube wells

c. Non-domestic for Khokhas and Temporary Structure

i. Teh Bazaari Receipt Number

ii. No Objection Certificate for Khokha/Temporary Structure for single delivery supply

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 d. Charging station for electric vehicles

An undertaking by the applicant that the charging station for electric vehicles is as per
the specifications as may be specified by Central Electricity Authority or Bureau of
Indian Standards from time to time.

8. The above referred applicable documents/certificates indicated at various points are

available with me and can be inspected by the Licensee at any time. In case of any
failure to produce the same, the licensee may disconnect the connection granted owing to
such failure, reluctance on my part to produce/allow the inspection of said
documents/certificates.

9. That I will provide a copy of any of above applicable documents to the licensee pursuant
to request of any external government agency, judicial forum or any other authority
seeking such information.

10.That my industry/trade has not been declared to be releasing obnoxious

hazardous/pollutant by any government agency and that no orders of any court or judicial
authority would be breached by running of my industry/trade or granting any electricity
connection to the same. The licensee is indemnified against any loss accrued by the
applicant on this account.

11.The applicant further agrees to indemnify and hold harmless, the licensee, in case of any
injury or incident on account of any fault in electrical work in the premises. The licensee
shall not be liable for any mishap or incident occurring at the premises to the applicant on
account of any faulty/defective/inferior quality wiring at the premises for which the
connection is being applied.

12.To pay the electricity consumption bills and all other charges at the rates set out in the
licensee’s Tariff Schedule and miscellaneous charges for supply as may be in force from
time to time, regularly as and when the same becomes due for payment.

13.To deposit the additional security deposit and additional service line cum development
(SLD) charges, if any from time to time based on the prevailing Orders/rules, directions
and Regulations of the Commission.

14.To abide by the provisions of the Electricity Act, 2003, all applicable laws, conditions of
Supply/Tariff Orders and any other Rules or Regulations as may be notified by the
Commission, as applicable from time to time.

15.That licensee shall be at liberty to adjust the electricity consumption charges

due/outstanding along with any other charges against the Consumer Security Deposit
paid by the Applicant, in the event of termination of the agreement prior to expiry of the
contracted period or in case of any contractual default as per provisions of
regulations/rules/orders/directions of the Commission.

16.That as per Delhi Electricity Regulatory Commission (Supply Code and Performance
Standards) Regulations, 2017 or as amended from time to time, I shall provide suitable
and adequate space for installation of the meter/electrical equipments where the licensee
may have ready access to the same.

17.To allow clear and un-encumbered access to the meters for the purpose of meter reading
and it’s checking etc.

18.That the Applicant would let the licensee disconnect the service connection under
reference, in the event of any default, non-compliance of statutory provisions and in the
event of a legally binding directive by Statutory Authority (ies) to effect such an order.

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 This shall be without prejudice to any other rights of the licensee including that of getting
its payment as on the date of disconnection.

19.All the above declaration given by the Applicant shall be construed to an Agreement
between the licensee and the Applicant.

Signature of the Applicant

Name of the applicant

SIGNED AND DELIVERED

In presence of witness
Name of Witness

*Select whichever is applicable

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