(To be submitted in Duplicate) UTTAR PRADESH STATE ELECTRICITY BOARD Application for Electrical Connection for Industrial and Agricultural use (Application form for Power Load sanctioned by District level Udyog Bandhu) (Annexure of Board Order No. 3519-C/R.V.P.-16-1993 dated 7.7.93) To, The Executive Engineer Electricity Department 1 Name and address of Applicant 2 Father / Husband's name of Applicant 3 Name and address of the place where Electric Connection is required Village Mohalla Block District 4 (a) For demand of additional load Present Sanctioned Load Power ________________________________ HP Fan/Light _____________________________Watt Process for which present load is sanctioned Power ________________________________ HP Fan/Light _____________________________Watt Additional load required Process for which additional load is required (b) For New connection Expected Load Power ________________________________ HP Fan/Light _____________________________Watt Process for which Power is required 5 If there is a consumer near to the house of the applicant who has electrical connection for similar industry, then name and address of the consumer 6 Distance of process location from the nearest Electricity Pole Date____________________ (Signature of Applicant)
