FORM-3 APPLICATION FOR HUT SERVICE (Tamil Nadu Electricity Board) (Refer clause 27(3)of Tamil Nadu Regulatory commission, TAMIL NADU ELECTRICITY DISTRIBUTION CODE, Notification No. TNERC /DC/8/1 dated 21.07.2004) (Form of requisition for supply of Low Tension Energy 40 Watts to huts in Panchayats) To The Engineer of the Licensee Sir, 1. I hereby request you to supply electrical energy to my hut described below: 2. I agree to pay for energy, service connection meter rent and other charges including security deposit as demanded in accordance with the regulations prescribed by Tamil Nadu Electricity Regulatory Commission. 3. I wish to be charged under Tariff .... under schedule of the TNERC tariff order dated. 4. I agree to receive supply only for 40 W lamp and utilize the energy for my hut described hereunder and I agree that the authorities may disconnect the service connection in case I utilize the energy above 40 W. 5. In case I sell or otherwise dispose of the hut, I agree to give one Calendar month notice in writing and pay all the arrears to the Licensee. 6. I will make arrangements to make the single point wiring for lighting in my hut in accordance with the Code provisions and the safety rules prescribed by the Authority.I request the Licensee to provide single point wiring for lighting in my hut and the necessary payment will be made by me. 7. Self Declaration The service connection applied for the hut is owned by me and a) it is built in my patta land (Land Tax Receipt is enclosed) b) it is built in the private land and No Objection Certificate obtained from the landowner is enclosed. c) it is built in the poromboke land and No Objection Certificate obtained from the Officer (not below the rank of Deputy Tahsildar) is enclosed. (Delete clause not applicable) 8. Description of the premises (a) Name of the applicant (b) Father's Name (c) Adi Dravidar / Other Castes (d) Survey No. / identification of hut (e) Area of hut (f) Whether the hut constructed with clay soil / thatched roof (g) Village and Taluk (h) Tenanted by (Name in block letters) (i) Applicant's correspondence address Signature of the Consumer / left thumb impression
