FORM FOR ELECTRICITY CONNECTION To, Sir, I/we expect this from you that you will give us connection according to Indian Electricity Act 1910 ruleVI, I/we are living in the below mentioned area whose I/we am/are the owner, Please give us connection within a month or according to the date given by Director of Electric Safety. I/we also expect that you will give us a meter on rent according to Indian Electricity Act1956's rule 26. I/we am/are ready to deposit the required money. Details Of The Applicant 1. Name of Applicant :________________________ 2. Father/Husband Name :____________________ (recent passport size 3. Occupation/Post :_________________________ photograph) (Attach company's incorporation certificate & power of Attorney in case you are raking connection in name of company) 4. Address:_____________________________________________________ House No.:_____________________________________________________ Area :_________________________________________________________ 5. Is applicant owner of the building or living on rent: Owner / Rent Building Details 1. Name of the building owner :____________________________________ Permanent Address :_________________________________________ 2. Type of building: living/non living 3.Building is in multistory area: yes/no 4. Building is a part of developed area: yes/no 5. Name of developer of the building:_______________________________ (In case of building is in developed area / multi storey building area attach issue certificate of developer & N.O.C both attested) 6. Details of any existing Electric connection: Eelectric connection no.:_____________________ 7. Details of any ex electric connection: Electric connection No.:__________ Book No: ______________________ Date of Disconnection: ___________ 8. Distance of Electric pillar from the building:____________________ 9. Is there any house/plot between the electric pillar & your building: yes / no (If yes then submit a certificate of no objection from him / her) Applied Electric wire details 1.Reason Of Electricity : (a) for home use (b) Other than home use 2.Details Of Electricity Application : (a) present accepted load (b) Applied extra load Number of Electric Points Load(watts) Total Load(watts) Light Fan Plug Other Details Details Of Wiring Contractor Name & Full address:____________________________________________ . License No.:___________________________________________________ Date Signature of Applicant Declaration I/we declare that all the wiring work in building is complete & above all details are true as per my knowledge, if this turn out to be false then State electricity Board has got the full right not to issue electric connection to me/us & if a connection is issued on above false details then it has the right to disconnect it. Date Signature of Applicant VIDHUT SURAKSHA NIDESHALAY Karyapurak Certificate (To be filled by state govt. licensed broker) CONSUMER NAME:__________________________________________ FATHER / HUSBAND'S NAME:_________________________________ ADDRESS:__________________________________________________ CONDITION OF LOCATION:____________________________________ VOLTAGE SCHEME: (1)VOLTAGE:________________________________________________ (2) NUMBER OF PHASES:____________________________________ (3) AC / DC:_________________________________________________ WAY OF WIRING:____________________________________________ TYPE OF WIRING:___________________________________________ 220 / 230 VOLTS HIGH / VERY HIGH VOLTAGE PHASE I PHASE II PHASE III 400 / 440 VOLTS ESTABLISHMENT NO. TOTAL NO. WATTS NO. WATTS NO. CAPACITY NUMBER CAPACITY (1) POINTS OF LIGHT:_____________________________________ (2) POINTS OF FAN:______________________________________ (3) PLUG POINTS:________________________________________ (4) MOTORS / GENERATORS: (Full description required) II OTHER ELECTRIC GOODS (Full description required) (1)_________________________ (2)_________________________ TOTAL LOAD IN KILOWATTS : __________________________________ MAXIMUM CURRENT DEMAND (in Amperes) : _____________________ (On basis of total load) LEAKAGE OF CURRENT (anti electric resistors must be atleast 1 Mega ohm or as according to Bhartiya Manak Sansthan) RESULTS OF ANTI ELECTRIC RESISTORS AS GIVEN BY CONTRACTOR PHASE I & EARTH PHASE II & EARTH PHASE III & EARTH (1) BETWEEN PHASE & EARTH (2) BETWEEN NEUTRAL & EARTH PHASE I & II PHASE II & III PHASE III & I 3) BETWEEN WIRES RULE 29 :--- (i) tell about wiring work, used things, instuments are acoording to Bhartiya Manak Sansthan. (ii) tell that each circuit is controlled by different switches. (iii) tell that all switches are working on live conductors RULE 32 :---- VERIFICATION CERTIFICATE I/we _____________________ license holder electric contractor, license no. ________________ Verify the Following: (a) I do all electric work before (b) Mentioned connection's antielectric resistance checking is done by me or by my supervisor & their results are mentioned d by me or my supervisor (c) Connection is given under Electricity Rule 1956 & is according to Bhartiya Manak Sansthan (d) Above work is done by me / our staff Name of wiremen Permit no. validity date Signature Supervisor name certificate no. validity date Signature Apprentice Name & signature Date: Electricity contractor's Firm Name License no.:_________________________ License Category:____________________ Validity Date:________________________ Contractor's Signature: DECLARATION (to be given by customer) I certify that I have taken care of all the rules / regulations/ compulsory things as mentioned by State Electricity Board & Indian Electricity Rule 1956. Main fuse's maximum capacity Ampere is not more & any over loading or any increasement in connection will be done by taking permission of State Electricity Board's Licensee. Date: __________________ Customer's Name:_____________________ Signature: ___________________________ TEST REPORT (to be filled by supplier representative) Anti electric Resistor's Result----Phase I & Earth Phase II & Earth Phase III & Earth (i) Between phase & earth--Phase I & II Phase II & III Phase III & I (ii) Between Wires- Errors found (if any) in the electric connection & steps to remove them: -- 1. -- 2. -- 3. -- 4. --- Date: Supplier's Invigilators Name: Signature: Post: CERTIFICATE BY ELECTRICITY SEQURITY DEPARTMENT Inspection Result: Name of Inspection Officer: Signature: (attached the details) Inspection date: Post: << Printthisdocument Closethisdocument>>
