FORM-4 (Tamil Nadu Electricity Board) Application for High Tension (H.T) Service connections (Including addl. Demand). FORM OF APPLICATION OF NEW SUPPLY OR ADDITIONS TO CONNECTED LOAD AND HAVE MAXIMUM DEMAND EXCEEDING 63 KVA. (Refer clause 27(3) of Tamil Nadu Regulatory commission, TAMIL NADU ELECTRICITY DISTRIBUTION CODE, Notification No. TNERC /DC/8/1 dated 21.07.2004) 1. Name of Electricity supply Licensee and registered address: 2. Name of consumer and registered address 3. Address of consumer's premises at which supply is required 4. Nature of service 5. Voltage rating at which High Tension (H.T) supply is required. 6. Data on consumers load Notified connected load in H.P. M.D. in KVA Description As on date Subsequent additional sanction Estimated requirement now applied Total Brief details of industry to be served No. of shifts Probable date of load maturing Signature of Consumer Name (in capital letter) Date Office Seal. Note : The application shall be accompanied by the following documents (1) (a) When the applicant is the owner of the premises: Certified copy of the sale deed for the premises executed in his favour (or) Property Tax receipt for the premises in the name of the applicant. (b) When the applicant is not the owner of the premises: Consent letter from the owner of the premises (or) Proof of legal occupation (including lease deed) along with the following: (a) Indemnity Bond in Form 6 (b) Letter of acceptance to pay security deposit at twice the normal rate. (2) Partnership deed in case the applicant is a partnership firm or Memorandum / Articles of Association in case of companies registered under Companies Act. (3) Letter / Resolution authorizing the signatory (4) Site Plan " 7. Data to be furnished by Licensee 8. Information regarding priority whether there is any prior High Tension (H.T) applications in the connected area awaiting supply of power Estimated Capacity Nature Brief list of Approximate Any other increase in of existing of materials cost of remarks M.D. of the services if supply required i.e. giving affecting undertaking any DC /AC cable service the supply if any, the voltage transformer undertaking application is or low switchgear with recom voltage etc., particular ref. mended etc., to plant site location of consumer installation Materi-als in stock Materials to be ordered 1 2 3 4 5 6 Note :For the purpose of priority, the area served by the sub-station feeder will be taken into account. Signature of Licensee's Engineer
