APPLICATION FORM FOR PROVIDING SERVICE CONNECTION (FOR DOMESTIC & GENERAL PURPOSE CATEGORY) To, The Area Manager/ Asstt Executive Engineer Service Connection Sub-Division/ ....Distribution Sub-Division MeSEB_____________________ (Indicate the local area of the jurisdiction of the Engineer of the licensee) Sir, 1. I/We hereby request you to supply electricity to the premises located at the address more fully described below. I/we are the owner/ lawful occupier of the premises. 2. I/We agree to abide by the terms and conditions relating to the supply of electricity by MeSEB and to make all payments as may be required and also to pay regularly all charges as may become due. 3. a) Full name and address of the applicant with contact telephone number . b) Status in relation to the premises. Owner Occupier c) Location and address of the premises including Police Station. d) Nature of LT supply : Commercial Domestic Industrial General Purpose WSLT PL Agriculture Date: Applicant's Signature NB: The following documents are to be enclosed: 1) Test Report from Licensed contractor. 2) Agreement Form duly filled in. 3) Proof of ownership (in case applicant is owner). 4) Number of the nearest Electric Pole. 5) NOC of the owner of the premises( in case the application is an occupier). 1
