NEW CONNECTION APPLICATION FORM

Form Serial No. 100828314

Please fill the form in CAPITAL LETTERS (please ✓ on the appropriate box)

Notification No. 002041591482

CA No.

CONNECTION SERVICES (S) REQUIRED General

New Connection Meter
Meter Type
Type Connection Type
Cumulative built up area of building(sq.m.):
Temporary Long Total Area of Premises(sq.m.):
_______
Term (Min 45 to Single Phase Pre Paid
365 days) Build-Up Area of Premises(sq.m.):
No's of Floor (Including Basement & Shed):
90

1 GENERAL PARTICULARS
Title Ms. Age 58 Yrs. Date of Birth 09-Jun-1967
Applicant: MEENA DEVI .
Relationship WO: RAM DIYA
Type of Accommodation: Owned ( Owned / Rental/Lease / Company Department ______________________
Provided / Govt.Provided / Govt. House / DDA Flats / CGHS Flat /
J.J.Cluster / Others ) (Pls fill if tick on Govt) Division _______________________

2 Complete Supply Address

House/plot/premise no.
HOUSE NO : 112, FLOOR: GROUND, POCKET: 1, SECTOR: 22, STREET NO: , ROHINI,
Street
LANDMARK NEAR DDA LAND PARK
Area/colony
Pin Code 110086
Mobile No. / Telephone No. 9318488130 /
E-Mail: jiteshmittal56@gmail.com

3 Billing Address:
Same as above If different, Please specify below
Billing address Same as above.

4 Category for Electricity Usage (As per applicable Tariff Schedule): Non Domestic Customer less than 100 KW
Domestic Category-Residential/Hospital/
i vii DJB
Educational/ Institutions/ Religious/Charitable/Others
ii Non Domestic-Banks/ Chemist/ Tailors/Others viii DIAL
iii Industrial ix DMRC
iv Agricultural x Advertising (No. of Hoardings)
v Mushroom xi Charging of E-richshaw / E-vehicle
vi Public Lighting
Note: the applicant shall refer the applicable tariff schedule for correct tariff category. In case of any clarification,he applicant
shall seek help of the licensee

Purpose of Supply (e.g. Shop/House/ Factory/ Godown/Parking/ Public

5
Utility etc

CIN NO. : U40109DL2001PLC111526, E - mail: customercare@tatapower - ddl.com , Website: www.tatapower - ddl.com

 6. Total Applied Load 0 KW 1 KVA
7. Contract Demand Applied KW KVA

8 a. PAN NO. : (For correct decution of TDS, if any)

b. GST NO.:
c. AADHAR NO: XXXX0029
d. INDUSTRIAL LICENCE NO:
Please indicate whether you want to purchase your own CEA approved meter having additional Meter Provided by
9
features as approved by the commission. TPDDL
10 List of Document attached: xxx documents
A. Photo Identity Proof submitted along with this application (ii) Proof of ownership or occupancy of premises for
form > applicant is a person (tick any One) which electricity connection is required (tick any one)
i. Electoral Identity Card i. GPA/Sale Deed/Conveyance Deed

ii. Passport ii. Allotment / Possession Letter

iii. Driving License iii. Registered Partition Deed

iv. Ration Card having photograph iv. Khatoni / Lal Dora Certificate
Letter of Commencement/Tender
v. PAN Card v.
Acceptance Letter
vi. Aadhar Card vi. In case of tenant
Photo identity card issued by any government a) Rent receipt (last 3 Months)/ Lease
vii.
agency Agreemen
b) No Objection certificate from
viii. Others
Landlord
If applicant is and organization (tick applicable) Certificate of
c) Proof of Ownership of Landlord
incorporation/ registration issue by the registrar.
vii. Others
11 Declaration Form (Attached) Yes No

Note: (please ✓ on the applicable box) Declaration

I, MEENA DEVI . , WO: RAM DIYA Resident of HOUSE NO : 112, FLOOR: GROUND, POCKET: 1, SECTOR: 22, STREET NO: ,
ROHINI, LANDMARK NEAR DDA LAND PARK (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 reffered to as "Applicant" which expression shall,unless
repuguant 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 HOUSE NO : 112, FLOOR: GROUND, POCKET: 1, SECTOR: 22, STREET
NO: , ROHINI, LANDMARK NEAR DDA LAND PARK (hereinafter the "Premises").

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.

CIN NO. : U40109DL2001PLC111526, E - mail: customercare@tatapower - ddl.com , Website: www.tatapower - ddl.com

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 right 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 undertakes:

1. That no objection certificate for seeking electricity connection from the co-owner has been obtained (in case the applicant is not the
sole owner of the premises).

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/designated officer of the Government#
and the test certificate is available with the applicant:

#in case of Government quarters/offices,

5. That the building has been constructed as per prevalent building Bye-Laws and the fire clearance certificate, if required, 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 (Tick whichever is available)
a. (i) Valid Industrial License; or
(ii)Factory License; or
(iii)Household License; or
(iv)Lal Dora Certificate in case of rural village; or
(v)Any other document authorizing the applicant to run the industry OR
b. (i)Occupancy-cum-completion certificate from concerned Municipal Corporation or DDA; or
(ii) Consent to Establish from Delhi Pollution Control Committee (DPCC);or
(iii)Provisional Industrial License; or
(iv) Sanctioned building plan from concerned Municipal Corporation or DDA

B. Agricultural Consumers
i. Certificate of Residence from Block Development Officer; or

C. Non-domestic for Khokhas and Temporary Structure

i. the Bazaari Receipt Number; or
ii. No Objection Certificate for Khokha/Temporary Structure from concerned Municipal Corporation of Delhi or Delhi
Development Authority or any other concerned Land Owning Agency

Please provide following information in respect of certificate available with the applicant-
(Certificate No., issuing authority, date of issue, Purpose, validity, if applicable)

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. *That the industrial connection is taken based on the documents mentioned in clause 7A (b) above and I shall obtain the valid
document as mentioned in clause 7A(a) above within a period of 3 months from issue of electricity connection.

CIN NO. : U40109DL2001PLC111526, E - mail: customercare@tatapower - ddl.com , Website: www.tatapower - ddl.com

*Strike out if not applicable

9. That 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 failure reluctance to produce/allow the inspection of said documents/certificates the licensee may
disconnect the connection granted owing to such failure/, reluctance

10. That I shall provide a legible and certified copy of any of above applicable documents to the licensee pursuant to order/request of any
government agency, judicial forum or any other authority seeking such information.

11. 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 that on an Order issued by a Court of law
or judicial authority or any government agency for disconnection of electricity, the licensee may disconnect the supply.

12. That I shall indemnify and hold harmless, the licensee, in case of any injury or incident on account of any fault in electrical work in the
premises and 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

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

19. That the licensee may disconnect the electric supply 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. This shall be without prejudice
to any other rights of the licensee including that of getting its payment as on the date of disconnection.

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

Name of the Applicant

SIGNED AND DELIVERED

In presence of witness
Name of witness
I hereby undertake to opt for whatsapp services provided by Tata Power-DDL
*Select whichever is applcable

Undertaking cum Declaration

I, MEENA DEVI . , WO: RAM DIYA Resident of HOUSE NO : 112, FLOOR: GROUND, POCKET: 1, SECTOR: 22, STREET NO: ,
ROHINI, LANDMARK NEAR DDA LAND PARK in occupation of property bearing No.……………do and hereby declare, affirm and

CIN NO. : U40109DL2001PLC111526, E - mail: customercare@tatapower - ddl.com , Website: www.tatapower - ddl.com

undertake as follows:
OR
I, , (AUTHORIZED REPRESENTATIVE/) of M/S hereby declare, affirm and undertake:
1. That I have applied to TPDDL for grant of a new temporary electricity connection at the said premises inthe name of Ms.
MEENA DEVI . OR M/s (name of company, etc.) on 26-Jun-2025 (date)…vide request no . That I am the person in-charge
of and responsible for the day to day affairs of the said premises/company/firm.
2. That I have been informed about obtaining No Objection Certificate or the permission from concerned authorities such as
Electrical Inspector or local authority etc, in taking this temporary connection.
3. That requisite No Objection Certificate (NOC) or permit, as intimated/required for the activity for whichconnection is
applied for, is available with me.
4. I unconditionally undertake to keep TPDDL /its officers indemnified against any
losses/damages/risks/liabilities/claims/risks/liabilities/claims/prosecutions/fines/levies/compensations/ proceedings
which TPDDL may be subject to or be made liable for or made to suffer as a result of breach of any obligations,
commitments made by me for release of the new connection sought by me, on the basis of this Undertaking including any
legal or other expenses reasonably incurred by TPDDL in defending itself/ its officers as well as for the cost /
compensation(s) to which TPDDL may be subjected to, under any law or pursuant to directions of any
court/tribunal/authority , if any, as a result of my failure to comply with the terms /conditions of this Undertaking.
5. This indemnification shall be without prejudice to TPDDL's right to disconnection of electricity at the abovepremises and
initiation of appropriate legal proceedings.

I state that the above statements, declarations are true and correct. TPDDL may accept the present undertaking cum declaration and
accordingly act upon the same.

In the event, any statement made herein is found to be incorrect at my behest, TPDDL may discontinue supply and initiate action(s) as
per applicable law against me.

Note: (please ✓ on the applicable box) Declaration

I, MEENA DEVI . , aged about 58 years, on behalf of (Name of Consumer’s Company)being its Authorized Representative having its
Registered Office/Residing at HOUSE NO : 112, FLOOR: GROUND, POCKET: 1, SECTOR: 22, STREET NO: , ROHINI, LANDMARK
NEAR DDA LAND PARK hereby declare and acknowledge as follows:

1. That I/our company has entered into an agreement with Tata Power DDL (DISCOM in North and North-West Delhi) for obtaining
ancillary services (including Deposit Works) covered under Circular No.-34/8/2018-GST dated 01.03.2018

2. That the Hon’ble Delhi High Court vide its judgment/order dated 13.12.2023 in WP 9455/2018 in the case of BSES DISCOM quashed
the circular bearing no 34/8/2018. It is given to understand that this order of the Hon’ble Delhi High Court is an order in rem and would
be equally applicable on Tata Power DDL, being similarly placed DISCOM.

3. That in compliance of the aforementioned judgment/order dated 13.12.2023, Tata Power-DDL has ceased to levy GST on the
ancillary services (including Deposit Works) covered under Circular No.-34/8/2018 w.e.f. 01.01.2024. However, the subject matter is
pending adjudication before the Hon’ble Supreme Court in a Civil Appeal bearing No.6278 of 2019 filed by the GST Department
challenging the order dated 19.12.2018 of the Hon’ble Gujrat High Court which quashed this Circular No.-34/8/2018.

4. I irrevocably and unconditionally agree to indemnify and keep Tata Power DDL and its affiliates (including their directors, officers,
employees and agents) fully indemnified at all times including but not limited to any past or future tax liability, its associated costs and
other penal implications, if any in relation to the GST applicable on the ancillary services (including Deposit works) subject to the final
outcome of Civil Appeal No. 6278 of 2019 before the Hon’ble Supreme Court.

5. I further agree to indemnify and hold harmless directors, officers, employees, and agents of Tata Power-DDL against any claims,
damages, recovery of past GST refunded or liabilities arising from such tax obligations or assessments resulting from the outcome of
the aforesaid matter pending before the Hon’ble Supreme Court.

I hereby scribe my hand to the above covenants on this 19 day of 6, 2025 at Delhi.

CIN NO. : U40109DL2001PLC111526, E - mail: customercare@tatapower - ddl.com , Website: www.tatapower - ddl.com

Signature of the Registered Consumer/User
Date:

CIN NO. : U40109DL2001PLC111526, E - mail: customercare@tatapower - ddl.com , Website: www.tatapower - ddl.com