FORM-IV FORM FOR LODGING COMPLAINT FOR DELAY IN ISSUE OF DEMAND NOTICE & RELEASE OF NEW CONNECTION/EXTENSION IN LOAD To be filled in by Consumer Sub Division : ______ Complaint Ref. No.____ (To be given by HPSEB) 1. Name of the applicant and address of the premises for which power supply has been applied 2. Date of application for power supply along with documents submitted therewith 3. Load and purpose for which power supply is required 4. Reference of Demand Notice issued by HPSEB, where applicable 5. Receipt No. and date of depositing the charges as per Demand Notice, where applicable 6. Details of the complaint 7. Date of lodging the complaint Signature of Applicant Tear off (To be perforated) ........................................ ACKNOWLEDGEMENT TO BE FILLED IN BY HPSEB AND HANDED OVER TO THE APPLICANT. Dated: 1. Complaint Ref. No. (to be given by the HPSEB) 2. Applicant's name 3. Brief detail of complaint 4. Received on date 5. Complaint received by 6. Deficiency noticed in the application/ documents required from the consumer 7. Target date to resolve complaint Signature of Authorized Officer Designation: SEAL
