H.P.S.E.B. Form CS-1 (a) Himachal Pradesh State Electricity Board Serial No. MM No. __________ NOTICE The applicant should hand over this application to the Local APPLICATION & AGREEMENT Application No......... Office of the Electricity Board in for Date of Receipt......... the area in which the supply is Supply of Electricity to required alongwith a non-judicial Domestic & Connection No......... stamp paper for Rs.3.00 duly Non-Residential crossed and signed. Consumers To The............Engineer, Himachal Pradesh State Electricity Board, ................. I/We hereby agree to take from the Himachal Pradesh State Electricity Board (hereinafter referred to as the supplier) at the premises stated below, a supply of electrical energy not exceeding the connected load/contract demand of my/our installation as noted below and I/we hereby further agree to pay for the said supply in accordance with the relevant tariff and also to pay for all such other charges as may become due by me/us to the supplier from time to time at rates laid down in the schedule of General & Service Charges prescribed by the supplier and I/we further agree that I/we will, if and when required by the supplier to do so, lodge with the Local Office of the Electricity Board a deposit calculated as per the conditions of supply prescribed by the supplier. And I/we hereby declare that the said conditions of supply, including schedule of tariffs & General & Service Charges have been perused by read to me/us and I/we agree to be bound by them and by the provision of electricity Act and of the rules made thereunder, as may be applicable. (I) I/we agree to be bound by the provisions of the Indian Electricity Act, 1910, I.E. (Supply) Act, 1948 and Indian Electricity Rules, 1956. (II) I/we further require you to supply me/us meter/meters on hire in terms of Section 26 of Indian Electricity Act, 1910 and I/we agree to give you such security as may be required for the price of the meter/meters and in terms of standing instructions of HPSEB. (III) I/we agree that in the event of failure of my/our part to make payment of the Board's dues, for this connection, it would be within the Board's lawful right to transfer the same to my/our other connections and these connections can/will be liable for disconnection for continued default, under Section-24 of the Indian Electricity Act, 1910. (IV) I/we agree that in the event of the failure to avail the connection the Advance Consumption Deposit, deposited by me/us may be forfeited as per standing rules of HPSEB. Name of applicant...................................... Occupation..............Description of premises.................. No. of Rooms.............House No...........Road............ Locality................Town.......................... The wiring work will/has been carried out by (Name)........................ (Address)........................................... Schedule of energy consuming apparatus to be connected: - Lamps, Tubes etc. Fans, Heaters & Refrigerators etc. MOTORS No. Wattage each Total Description Wattage each Total watts No. B.H.P. each Total KW Total: 2. Connected load of above installation (3+6+9).......................Watts/Kilowatt 3. Voltage at which supply would be preferred............................. 4. Purpose for which connection is required.............................. (Domestic/Non-Residential) 5. Class of Application: (a) A new connection: (i) I am owner/landlord of the premises. (ii) My/our landlord agrees to me/our taking the said supply and his written consent is enclosed herewith. (iii) It has not been possible for me/us to obtain consent of my/our landlord and I/we hereby agree to keep indemnified & harmless the supplier against all claims made and action & proceeding taken by the landlord or any person claiming through or under him by reason of the giving of the electric connection by the supplier to me/us. Indemnity bond to this effect is enclosed. (b) An extension to my/our existing installation (Connection No....................) (c) A reconnection (the previous consumer's name is........................ and his Connection No. is...................) (d) A change of name from (Shri..................Connection No..........) 6. Whether permanent or temporary connection............................. 7. Approximate date from which connection is required.......................... Signature of applicant........................................ Present address of applicant.................................... Permanent address of the applicant.................................. 8. WITNESS: Signature of witness....................Name................ Account No..............Permanent Address...................... Date........... Note:- (i) Application & Agreement Form will not be signed by a minor. (ii) The Indemnity Bond as per Clause 5(iii) shall be obtained from the consumers on non-judicial stamp paper of the value of Rs.15/- on Board standard proforma. (iii) No interest shall be paid by the Board on Advance Consumption Deposit. (FOR OFFICE USE ONLY) 1. Pressure of supply is...........Volts 2. Schedule of tariff applicable........... Accepted on behalf of HIMACHAL PRADESH STATE ELECTRICITY BOARD By Signature......... Date........... Designation........ ACKNOWLEDGEMENT Received the application of...................on................. As per Serial No..................which should be quoted in all future correspondence. Signature & Designation of the Officer Receiving the application
