FREE OF COST

TP NORTHEN ODISHA DISTRIBUTION LIMITED

(A Tata Power and Odisha Government Joint Venture)

Form No. 1
(See Regulations 3)
APPLICATION FORM

New Service Connection / Load enhancement/ Load reduction/ Reconnection /Change of Name/
Shifting/ Temporary Supply/ Conversion of Service/ Change of consumer category
(FOR DOMESTIC & GENERAL PURPOSE OTHER THAN BULK DOMESTIC SUPLY CATEGORY)

To Affix photograph ofthe

The Junior Engineer/ Sub-Divisional Engineer, Applicant here
Name of the Section :-
Name of the Sub-Division :-
Sir/Ma’am,

1. I/We hereby request you for a new service connection to supply

electrical energy to the premises owned / occupied by me/ us and hereinafter described. I/We am/are
the owner/lawful occupier of the premises at ............................................ in which supply of electrical
energy is now required.
2. I/We agree to take supply for TWO YEARS to utilize the energy for General Purpose/Domestic
purposes only for my/our use. Thereafter Agreement shall so continue unless terminated by either of
the parties after giving one month's notice.
3. I/We agree to pay for the service connection and other dues including the security as may be payable
and shall also pay the charges, surcharges, electricity duty in accordance with the OERC Distribution
(Conditions of Supply) Code, 2019 provided that annual sum payable individually by me/us under the
proviso Section 45 of the Electricity Act, 2003 shall not be deemed to be part of the minimum
monthly charges or demand charges, if any, payable under the OERC Distribution (Conditions of
Supply) Code, 2019.
4. I/We have obtained and perused a copy of OERC Distribution (Conditions of Supply) Code, 2019 and
understood its contents and hereby undertake to observe and comply with the terms and conditions
stipulated therein to the extent they are applicable to me/us.
5. I/We further require you to supply me/us with the necessary meter/meters on hire in terms of Section
55 of the Electricity Act, 2003. I/We agree to give you such security [as per Section 47(1) (b)of the
Electricity Act, 2003] as may be required for the price of the meter/meters, whenever called upon to do
so. (Strike out if meter to be supplied by the consumer).

6. Details of Applicant & Premises (where power supply is required):

a. Consumer Details:
Sl. No Particulars
1 Application For:
New connection  Shifting of meter 
Load Enhancement  Temporary Supply 
Load Reduction  Conversion of services 
Reconnection  Change of consumer 
category/classification
Change of Name/Transfer of 
service connection
2 Name of the Applicant/
Organization:
(In Capital Letters)

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: [email protected], Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)

Name of father/ husband/

3 Director/Partner/Trustee:
(In Capital Letters)
4 Consumer No.
(If application is not for New Connection)
5 Purpose of power supply (Tick mark only one of the appropriate option) :
Residential  Agriculture 
General Purpose  Waterworks 
Industrial  Street Lights 
Institutional  Others (Please Specify) 
6 Category of supply:
7 Type of Supply (Tick mark only one of the option) :
Permanent  Temporary 
If Temporary supply, specify period of From Date:
requirement: (dd/mm/yyyy)
To Date
(dd/mm/yyyy)
8 Legal status of applicant:
Owner  Tenant 
9 Nearest Connection No:
10 Written permission of the Yes  Applicable Not Applicable
landlord/owner including
legal heirs tendered:
11 Written Permission of Way
Leave (Furnish if required):
{Refer to Regulation 15 of the OERC Distribution (Conditions of Supply) Code, 2019}
12 Address Details of the premises for which new service connection is applied for / existing
connection is required to be shifted
Name of Applicant (In Capital Letters):
First Name:
Middle Name (If any):
Surname:

House/Flat No: Plot/Holding No. :

Village/Town/Street: Ward No:
Nearest Landmark:
District: Pin code:
13 Postal Address Details for Communication:
Name of Applicant
(In Capital Letters):
House/Flat No: Plot/Holding No. :
Village/Town/Street: Ward No:
Nearest Landmark:
District: Pin code:
Phone/Mobile No:
Email Id:

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: [email protected], Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)

b. The following are my/our electrical installation to be fixed in the premises:

Item Load per Item (Watts) No. of Items Load

(1) (2) (3) (4)=(2) X (3)
Tube light 40W
LED Tube light/Lamp 18/12 W
Incandescent lamp 60W
Table Fan / Ceiling Fan (36”) 60 W
Air Circulator 180 W
Ceiling Fan (48”) 60 W
Ceiling Fan (56”) 70 W
Exhaust Fan 75W
Music system 40 W
Television (Portable) 65 W
Television 125 W
Mixie/Grinder 500 W
Electric Iron 450 W
Fridge (Single door) 1/8 HP (100 W)
Fridge (Double door) 1/6 HP (125W)
Cooler 170 W
Heater (for cooking) - according
1000/1500 W
to physical availability
Heater (for water heating) 1000/1500 W
Microwave oven 600/900 W
Washing machine 340 W
Kitchen Exhaust Chimney 45 W
Aqua guard filter m/c 30 W
Air conditioner (1 Ton) 1000W
Air conditioner (1.5Ton) 1500W
Geyser 1500 W
Geyser (Instant) 2000W
Pump Set 375 W
Personal Computer with Monitor 120 W
Printer 100 W
60 W unless otherwise
declared by the
Each light point as
consumer, which will be
final

The Total Load applied for (in kW): .

Note :
(i) Addition or omissions to the connected load/contract demand to be notified to the
licensee and permission obtained before effecting such changes.
(ii) In case of non-availability of rated capacity of any item, the load shown above shall be
considered for Domestic and General Purpose category of consumers.
(iii) The consumer shall have the option to procure meter by himself /herself from theapproved
vendors of the licensee.

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: [email protected], Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)

c. List of Documents required:

Identity Proof submitted along with this application

form:
- If Applicant is a person(Tick any one) (i) Aadhar Card
(ii)Electoral identity card;
(iii) Passport;
(iv) Driving license;
(v) Ration card;
(vi) PAN card;

If Applicant is an organization(Tick any one) Signature of competent authority (e.g. Branch

Manager, Executive Engineer, etc) along with
relevant resolution/authority letter of the institution
concerned/Head of the Institution

Proof of ownership of occupancy of premises for (i) Copy of sale deed or lease deed or Record of
which electricity connection is required Right (RoR)
(Tick any one) (ii) Registered General Power of Attorney;
(iii) Municipal tax receipt or Demand notice or
other related document;
(iv) Letter of allotment.
(v) An applicant who is not an owner but an
occupier of the premises shall along with any one
of the documents listed at (i) to (iv) above also
furnish a no objection certificate from owner of the
premises(owner includes legal heirs)

Proof of current address (i) Aadhar Card

(Tick any one) (ii) Electoral identity card;
(iii) Passport;
(iv) Driving license;
(v) Ration card;
(vi) Statement of running Bank Account;
(vii) Water / Telephone / Electricity / Gas
connection Bill;
(viii) PAN Card

Any other document as applicable (Please specify)

7. Any electricity dues outstanding in licensee’s area of operation in consumer’s name : Yes/ No

8. Any electricity dues outstanding for the premises for which connection applied for : Yes/ No

9. Any electricity dues outstanding with the licensee against any firm with which the consumer is
associated as an Owner, Partner, Director or Managing Director : Yes/ No
(For questions 7, 8 & 9 if the answer is ‘Yes’ in any case please provide details on a separate sheet)

10. Report of the Electrical Inspector/Licensed Contractor, as the case may be.

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: [email protected], Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)

11. I/ We hereby declare that:

(a) The information provided in this application is true to my knowledge.

(b) I/ We have read the OERC Distribution (Conditions of Supply) Code, 2019 and agree to abide
by the conditions mentioned therein.
(c) I/ We will deposit electricity dues, every month, as per the applicable electricity tariff and
other charges.
(d) I/ We will own the responsibility of security and safety of the meter, cut-out and theinstallation
thereafter.
(e) I/ We have no outstanding dues payable to the present distribution licensee or any other
distribution licensee within the state of Odisha incidental to the use of electricity.

Date: Signature of the consumer/ Authorised Signatory/ Joint

signature in case of tenant applying for power supply
Place: Name:
(i) Owner :

(ii) Tenant :

Note: Apart from documents for identity proof, proof of ownership/occupancy of premises and proof of
current address, the following documents shall be attached with the application form:
1. In case of a partnership firm – The applicant shall furnish the partnership deed and an authorization in
the name of the applicant for signing the requisition form and agreement;
2. In case of Public and/or Private limited Company – The applicant shall furnish a Memorandum and
Articles of Association and Certificate of Incorporation along with an authorization in the name of the
applicant for signing the requisition form and agreement;
3. Other documents applicable only for select consumer categories:
(a) Industrial consumers: Valid Industrial License, if applicable
(b) Agricultural consumers: No Objection Certificate from competent government for tube wells, if
required. Also an undertaking for use of electricity supply for agricultural purpose only.
(c) Non-Domestic Temporary Structure: No Objection Certificate for temporary structure from the
Municipality/NAC /Gram Panchayat /land development authority / land owning agency, as the case
may be.

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: [email protected], Website: www.tpnodl.com
CIN: U40106OR2021SGC035951