Form

NOIDA POWER COMPANY LIMITED
Commercial Complex (First Floor)
H-Block, Alpha-II Sector,
Greater Noida - 201 306

(FOR OFFICE USE ONLY)

REFERENCE NO.

TARIFF

Requisition Form for Electricity Connection

Please Remember

	Fill the Requisition Form in BLOCK LETTERS.
	Tick (b) wherever applicable.
	Furnish correct information.
	Supply will be commenced only on completion of wiring installation.

Applicant's Name

Father's Name

Mailing Address

PIN

1. Applying for:

New Connection

Shifting of Service

Reduction of Load

Additional Load

Change of Name From

Any Other: Please Mention

2. Supply Required at:

Premises No.:

Pocket:

Sector/Site/Village:

Road:

PIN:

Telephone No:

3. Plot Size:

Applied Load (KW / HP / KVA):

4. Supply to be used for:

(Please mention detail such as 'Light, Fan & Power load of a factory producing sports goods)

5. Consumer No. and Meter No. of

(a) either a meter holder of the house if provided with electricity OR
(b) a meter holder in the nearest house having supply, in case your house does not have electricity

CONSUMER NO.

METER NO.

6. Existing Consumer No. and Meter No. (for existing supply):

CONSUMER NO.

METER NO.

7. Nearest Lamp Post No. / Feeder Pillar No.:

8. Proposed Location of the Meter Board:

Service Line Permission - Noida Power Company Limited
(Please sign wherever applicable)

With reference to Premises No. __________________________

1. I/we being owner (s) of the of the building have no objection to supply being given to _________ _________________________________ and hereby grant permission for :

a) Installation of a Service line, Cut-out & Meter board
b) Alterations to the existing Service line, Cut-out & Meter board and/or
c) Use of existing spare Loops

Signature _________________ Date _________________

2. I/We being owners of the land at the above premises hereby grant permission for a Service line to be laid or altered through or over my/our land at the said premises.

Signature ____________________ Date _________________

3. I/We being occupier (s) of that portion of the above premises where the Meter Board is fixed allow that the additional space be occupied by the Licensee's Meter Board.

Signature____________ Date _________________

NOTE

The Service Line Permission and Declaration must be signed by the actual owner(s). If signed by the person authorised to sign on behalf of the foregoing person(s), the legal authority must be plainly stated.

It is not incumbent on Noida Power Company Limited to verify the genuineness of the signatures above. The above permission will be accepted in good faith & consequences of false signatures will be the consumer's responsibility.

DECLARATION

I/We hereby declare that I/we desire to have and agree with the Licensee to take a supply of energy for the above mentioned purposes, for a period of not less than 2 years from the date of commencement of supply and to pay for the energy so supplied and all other charges at the rates set out in the Licensee’s Tariff Schedule as may be in force from time to time. I/We also agree to be bound by the Licensee’s own/adopted Conditions of Supply including any modifications thereof and the provisions of Indian Electricity Act, 1910 together with the Rules framed thereunder and Electricity (Supply) Act, 1948 in so far as they are applicable. I/We also declare that in the event of my/our failure to comply with the above provisions, it will be lawful for the Licensee to discontinue the supply in terms of the aforesaid Act/Conditions of supply. I/We further declare that the Licensee shall not be held responsible for any interruption/diminution of supply for reasons beyond its control. I/We understand that this declaration can be cancelled after two years by either party after giving one month’s notice without prejudice to the rights which may have accrued to the Licensee in the mean time. I/We further agree that this declaration given by me/us will be construed as an Agreement with the company to the above effect.

I/We declare that all details furnished in the Requisition Form are true to my/our knowledge. If any information is found incorrect at a later date, then the Company will have the right to withhold/disconnect supply, as the case may be.

Applicant’s signature _____________________________ Date ____________________

SPACE FOR A ROUGH SKETCH SHOWING THE EXACT LOCATION OF THE PREMISES

Note: FOR CASES OTHER THAN NEW DOMESTIC CONNECTIONS, A SEPARATE AGREEMENT IN THE REQUIRED FORMAT ON STAMP PAPER IS TO BE EXECUTED