GOVERNMENT OF GOA ELECTRICITY DEPARTMENT Form of requisition for Supply of Energy Under Clause VI (5) of the Schedule to the Act To, The Executive Engineer (Electrical)/Assistant Engineer (Electrical)/Officer-in-charge/Sub-Section. Electricity Department, Government of Goa, Daman and Diu, ................................................. (Local Office) Sir, I/We hereby require you, in accordance with Clause VI of the Schedule to the Indian ElectricityAct, 1910 within one month or within such longer period as the Electrical Inspector may allow,from the date of this requisition to supply energy for the premises owned/occupied by me/usand situated within the area of supply. I/We further require you to supply me/us with the necessary meter/meters on hire in terms ofSection 26 of the Indian Electricity Act, 1910, I/We agree to give you such security as may berequired for the price of the meter/ meters, whenever called upon to do so. 2) Applicant's name. (In Block Letters): Occupation/Designation Description of premises. House No. and or Name of the premises. Owner's name......................... .................................................................... .... Owner's address .......... ................................................. ...... Street...............Town/Village.................Taluka....District................................. ......... A) Domestic or Residential................. ......... (a) Lights & Fans ...................... (b) Heating & Small Power B) Commercial (a) Lights & Fans ...................... (b) Heating & Small Power No. of points wattage Total Wattage C) Industrial Power Motor & or //apparatus. (a) Low Voltage ........................ (b) Medium Voltage ................. (c) High Voltage ....................... Total connected load applied for Watts/Kilowatts H.P. No. of Points H. P. & K. W. Total Purpose P.T.O 5) The following are my/our requirements. (1) A New Service. (2) A sub-service from an existing service: The name and address of the consumer whose service is to be tapped His service No. is (3) An extension to my existing installation from Service No. (4) A re-connection of Service No. ........................ (5) A change of name from Service No. (6) The system of wiring will be (7) The wiring work will be carried out by Wiring Contractor's Licence No.: Name: Address: Applicant's signature: Present Address: Date:The.......day of.........200..... NOTES: 1) The applicant is requested to complete the clause referring to this requistion and to strike out the clauses which are in applicable. 2) Under clause VI (1) 15t proviso of the Schedule to the Indian Electricity Act, 191O, the Electricity Department shall not be bound to comply with any such requistion unless and until the person making it a) Within fourteen days after the service on him by the Electricity Department of a notice in writing in this behalf, tenders to the Electricity Depar1ment a written contract in the form approved by the Government of Goa, Daman and Diu duly executed and with sufficient security binding himself to take the supply of energy for not less than 3 years to such amount as will produce at current rates charged by the Electricity Department, a reasonable return to the Government; and b) If required by the Electricity Department so to do, pays to the Electricity Department the cost of so much of any service line as may be laid down or placed for the purposes of the supply upon the property in respect of which the requisition is made, and of so much of any service line as it may be necessary for the said purposes to lay down or place beyond one hundred feet from the Department's distributing mains, although not on that property. 3) In lieu of the contract referred to in Note 2(a) above, the Department is prepared to accept a declaration in the following from subject to deposit of any required security by the applicable: I/We hereby declare that l/We desire to have and agree with the Electricity Department to take supply of energy for the above mentioned purposes for a period of not less than two years from the date of commencement of the supply and to be bound to the provisions of clause VI of the Schedule of the Indian Electricity Act, 191O, and by the Electricity Department's charges, appropriate tariffs applicable to me/us and Conditions of Supply as are from time to time in force. One& half RupeeApplicant's Signature Stamp
