Form No.

(See Regulations 3)

New Servce Connection / Loed enhencementLoed Appliation Form # TPC10252633

reductiontReconmection tGhenge of Namet5httng-tenpot
SupplytConversion
FOR DOMESTIC &
GENERAL
of Service Ghange of constmer categon
PURPOSE OTHER THAN BULK DOMESTIC SUPLY
CATEGORT
The Junior
Engineer/ Sub-Divisional Engineer,
Angul No 1ANGUL Sub Division

Sir,

ve nereby request you for a new service connection to

supply electrical energy to the premises ownedi occupied by us and
nereinarterdescibed. IWe am/are the owmerilawful occupier of the me
prenvises at NA THANA CHOWK In wrhich supply or electhca
energy is now
2. w e
required
agree to take supply for TWO YEARS to utilise the energy for Commerclal purpOoses
only for iy/our use. Thereafter Agreefment
shall so continue unless terminated by either of the
parties after gring one month's nobce.
3. IWe agree to pay for the service connecion and other dues
including the security as may be payabie and shail ais0 pay tne
Surcharges, electrcity duty in accordance with the OERC Distribution (Conditions of Supply) Code, 2019 provided that annual sum cnarges
payabie atyicuaily tby meus under uhe proVISO Secton 45 of the Eecthcty Act, 2003 sthall not be deemed to be part of the minimumm
monthiy charges or demand charges, f any. payabie under the OERC DIstribudon (Conditions of Supply) Code, 2019.
4. 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 terrms and conditions stipulated therein to the extent they are applicable to me/us.
5. IWe further require you to supply merus with the neecessary meter/ meters en thre in terms of Section 55 of the Electhiaty Act, z00s.

eeto-seyo-e-eeunty es-per-Section-474Hef-the-EletictyAet-203tes-may-be-required feon-the priee ofte

etemetrw*enever eeed pon to de-e-(Strike out if meter to be supplied by the consumer)
6. Details of Applicant & Premises (where power
supply is required):
.

SI.
Particulars
1 Applicato For, New Connection

Name of the Applicant/organization (n Capital Letters): PRATAP SAHU

Name of father/ husband Director/Partner/Trustee:(n Son of CHEMUTU SAHU

Caprtal Letters)
Consumer No.(if application is not for New Connection): NA

PAN No.:

GST No
Purpose of power supply Commercial
Category O Suppey General Purpose single phase

Type of Supply Permanent connection

Temporary supply. speciy period of requirement: From-to

T0 Legal status of applicant Owner

11 Nearest Connection No:

12 VWntter permission of the landlord/owrer including leça Yes

n s lerdered.

Written Permission of Way Leave (Fumish if

required) Yos

(Reler to Regulation 15 of the OERC DIstibAticon (Conditikis of Supply) Code, 2019)

Address Detals of the
premisess for whicth new servIce
connecton is apiiecd for / eexisting connection iS
shifted required to be

Name of Applcant (In Capilal Lettrs):

ATAP SAHU

House/Flat No:
PoUtHolding No.NA

Mallane/Trwm/Sraat THANA CHOww Wart Ne NA

i
i
 (instan) 2000
umpSet 375

Personal Computer with Monitor 20

Printer

Each light point as

Others (f any)

The Total Load applied for (in kW): 0.5000 KW

C. List of Documents
required
ldentity Proof submitted along with this application form:

f Applicant is a person(Tick any one)

Proof of ownership of occupancy of premises for which electricity
connectiorn is required

Proof of current address:

i y oner document as applicable (Please Test Documents

specity
Note:

a. oditon Omission 1o the connected Ioad i contract dermand to be notifed to the licensee and pemission obtained before efecting such
Crianges
D. n case of o-avaiablity of rated capeclty d any tem, the load shown above shall be considered for Domestic and General purpose
calegory of consumerS.
C. n e consumer snal have he opbon to procure meter by himself / herself from the approved vendors of the licensee.

7. Any electricity dues outstanding in licensees area of operation in consumers name: NO

: NO
8.Any electicity dues outstanding tor the premises for which connecion apled for
3 . y eecncty dues oUStanding with the licensee Bgainst any firm with which the consumer is associated as an Owner, Partner,
Director or Managing Drector : NO
as case
0. Report of the Elecrical InspectorLicensed Contractor, the may be.
1. In case df New Connecton, IWe hereby decdare that there is no existing connection in applied premises.
12. In case of Additional Connection, IWe hereby declare that we have seperate Dwelling and Entrance on my applied premises.

Sgnature of he consumeri Authorised Signatory/ Joint signature in

case of tenant applying for power supply
Name:
() Owne
Tenant
Ncte: Apart rom documents for kdentity proo, proaf of ownershiploccupancy of premises and proof of current address, the following
documents shall be attached with the application form:

In case of a parthership firm - The appicant shall fumish the partership deed and an authorization in the name of the applicant for signing

the requistion form and agreement;

2. In case of Public and/or Private limited Company- The applicant shall fumish 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;
s. Oter documents applicable only for select consumer calegories:
A ncase a partnershi fm-Tne applicant shal furmish the partnership deed and an authorization in the name of the applicant for signing
he requisition form and agreement:
B. In case of Public and/or Private limited Company-The applicant shall furnish a Memorandum and Aticies of Association and Certificate of

Incorporaton along ith an authorization in he name of the applicant for signing the requisition form and agreenent
C. other documents applicable only for select consume categones

a. inousinai ConsurmerS: Valid Industnial License, T Bpplecabie

b.Agricultural consunmers: No Objecton Ceruhcate om compelent government for tube wells, if required. Aiso an undertakung tor use o
electricity Suppiy tor agrnicuitural purpose only.
c. Non-Domestic Temporary struclure: No Objecuon certfhicale lor temporary structure from the Municipality/NAC Gram Panchayat ard
development authonity land ownung agency, as the case may be
 Payment Receipt # 36750255219437

Pplication Details

Name PRATAP SAHU

Unique Pemanent Application TPC10252633

No(UPAN)
3 Application For New Connection (General Purpose single phase)
Registered Mobile No 9861764230

PAN No

GST No

Transaction Details

Payment Type Online Payment

Transaction ID YHD41577192418
Transaction Status
Successfu
Transaction Date 23-11-2022 00:00:00

Payment Details

SI No. Item Name Amount

I.
Processing Fees(Excl.GST @18%): 50.00
Service Connection Charges(Excl.GST
1500.00
@18%):
. Inspection Fees 50.00
4. Security Deposit : 1352.00

5. Meter Cost (Excl.GST @18%) 1271.00

Total (Including GST Charges of 18% i.e. 508.00) 4731.00
(Rupees four thousand seven hundred & thirty
one Only)

(NB: In case of rejection of application the Processing Fees, GST &

Iuspection fee is not refundable.)
This is a
computer-generated document. No signature is required.