PUNJAB STATE ELECTRICITY BOARD APPLICATION AND AGREEMENT FORM (For General Service Connections) Category -DS/NRS To The Sub Divisional Officer, ____________Sub-Division, PSEB, ___________________________ Sub: Contract Agreement for release of a new connection/extension /reduction in load. Account No.__________________(in case of extension/reduction in load only) 1. I/We hereby agree to take from Punjab State Electricity Board(hereinafter referred to as the Board) at the premises stated below, a supply of electrical energy not exceeding the connected load of my/our installation as below, and I/We hereby further agree to pay for the said supply in accordance with the relevant tariff as amended from time to time and also to pay for all such other charges as may become due by me/us to the board from time to time at rates laid down in the schedules of service and general charges prescribed by the Board from time to time. I/We further agree that I/We shall as and when required by the Board to do so, lodge with the local office of the Board Security Against Consumption as per provisions of 'Conditions of Supply' of electric energy by PSEB and schedule of general charges. I/We hereby declare that the said condition of supply including schedules of tariffs and schedules of general service connection charges have been perused/read by me/us and I/We agree to be bound by them as also the provision of the Indian Electricity Act,1910 and Electricity Supply Act,1948. 2. I/We further require you to supply me/us with the necessary meter/meters on hire in terms of section 26 of the Indian ElectricityAct, 1910. I/We agree to give you such security as may be required for the price of the meter/meters whenever called upon to do so. I/We agree to pay monthly rent for the meter(s) as fixed by the Board from time to time. 3. Description of Premises: House /Shop/ Premises No.______ Locality_____________ Town/ Village/ City_______________ Pin Code_______ Telephone No._____________________ 4. I/We declare on oath as under:- i. It is disclosed that I/We am/are major. ii I/We, am/are owner/landlord of the premises or my/our landlord/owner agrees to my/our taking the said supply from the Board. OR I/We are the lawful occupier/s of the premises but it has not been possible for me/us to obtain consent from the landlord and I/We hereby agree to keep the Board indemnified and harmless against all claims made and action and proceedings taken up by the landlord or any person claiming through or under him by reason of giving this electric connection by the Board to me/us. iii I/we hereby agree that I/We shall abide by the power cut restrictions/peak load hour restrictions imposed by the State Government/Board from time to time as per the provisions of Section 22A and 22 B of the Indian Electricity Act,1910. iv My/our premises are within/outside the municipal limit. v. My/our premises are ready and electrical installation complete in all respect to receive power. vi I/We shall provide space for the installation of motor at the main entry of the premises. The MCB shall be provided by me/us. vii The authorized representative of the Board can check energy consuming apparatus/installation at my/our premises at any time. viii There is no other electric connection running in the above premises. OR One No. DS/NRS electric connection already exists in the above premises and I/We want to take second connection for which I/We are ready to pay highest slab of tariff. ix There is no defaulting amount/theft case/pending court case of the board against my/our above premises. x I/We do not have any dispute of any amount with the Board anywhere in Punjab. OR I/We have a dispute of Rs. __________with Board for which compliance of instructions of Board on the subject has been made. xi The above premises is more than 5 mtr/30 Mtr/100 Mtrs away from the road reservation of Municipal Road./Schedule Road/Bye-pass. xii I/We have applied this electric connection for domestic purpose and no business activity shall be carried out in this premises without prior permission from the Board. OR i/We have applied this electric connection for non residential purposes only. C. SCHEDULE OF ENERGY CONSUMING APPARATUS Category Description No. Wattage each Total KW D. Light Load Lamps, Wall Plugs and other lighting load, etc. Light Points Fan Points Wall Sockets Total Light Load B. Power Load Air ConditionPower Plugs/Air Conditioners, etc. Power Plugs er Total Power Load C. Other Load ( if any) Motors etc. Total Other Load Total Connected Load(A+B+C) KW 6. I/We am/are enclosing herewith Wiring Contractors test report along with A&A form. A copy of Challan of CEI (Pb.) and permission accorded by him is also enclosed (wherever applicable). I/We also certify that I/We will not effect any change in wiring /connected load as given in the test load. VERIFICATION: I/we also undertake that the above information is correct and in case I/We violate any undertaking/instructions or any other information is found to be false at any stage, my/our electric connection may not be released and if released, it may be disconnected without prior notice and all charges deposited by me/us be forfeited. ___________________ Signature of the applicant(s) Date:_________ Name & Address:______________ _____________________________ For and on behalf of the Board ____________________ Signature of the SDO/AEE/XEN/Sr.XEN (OP) Date:__________________ Official seal (To be signed after release of load) FOR OFFICE USE ONLY A. ACTION BY R.A. Whether new/extension/reduction in load Existing Account No.___________ Existing connected load _____________ KW, Applied Load+ _______________Total Load _______KW Amount to be deposited on account of following:- (i) Security Against Consumption Rs.__________________________ (ii)Meter Security Rs.__________________________ (iii)Service Connection Charges Rs.__________________________ (iv)Special/Any other Charges Rs.__________________________ Total Rs.__________________________ Cashier please accept Rs._________________(in words)Rs.___________________________ Dated:____________________ Signature of R.A. Name:___________________ (NOTE: Test report received with the A&A form to be pasted in the case file). B. ACTION BY CASHIER Received Rs.____________(in words)Rs._________________________________________________ vide RO-4/BA-16 Receipt No ._______________________Book No .____________Dated___________ Signature of Cashier Name:____________________ (NOTE: RO-4 receipt shall be issued by the cashier to the applicant/consumer and shall send the case to Consumer Clerk. The consumer clerk shall make entry in the service connection register and pass on the case file to R.A) C. ACTION BY CONSUMER CLERK Entered in Service Connection Register at Serial No ._____________date________________ Signature of CC Name:_________________ D. FOR FURTHER ACTION BY RA Certified that the applicant has completed all the formalities and has deposited the required amount. Work for release of his connection/extension in load maybe taken in hand against the following sanctioned estimate. I Sanctioned Estimate No. __________Date ____________Operative period_________________ ii Sanctioned amount of the estimate Rs.____________________________ iii Amount already spent Rs.____________________________ iv Balance unspent amount Rs.____________________________ Date:_______________ Signature of R.A. Name:__________________ E. FOR ORDERS BY SDO/AEE/XEN(OP) INCHARGE i Issue Service Connection orders. ii The work may be carried by Shri. _________________________________ JE. Signature of SDO/AEE/XEN(OP) Name:________________________ F. ISSUE OF JOB ORDERS BY RA Service Connection Order No ._________________________Dated ________________in the name of Shri__________________________________ JE issued. Signature of R.A. Name:____________________ Dated:____________________ Signature of JE_______________________ Name_______________________________ Date:_____________ G. INFORMATION/CERTIFICATES TO BE RECORDED BY THE JE FOR RECORD. i The load has been checked at site and found to be ___________ KW. ii The connection/extension/reduction in load has been released on______________ iii The connection/extension/reduction in load has been released from__________(Name of Transformer) iv The connection/extension/reduction in load has been released from__________(Name of Feeder), Code No.__________. v The entry has been made in connected load register. vi Location of the premises of the applicant/consumer. Left Side existing Premises Applicant/Consumer Premises Right Side existing Premises Acct .No. Acct. No. vii Certified that the connection has been released without any violation of PSEB rules and regulations. OR Connection has not been released because of the following violations of rules. a. b. c d. viii Details of Material used for release of connection and its value: Sr. No. Item Quantity used Rate as per Estimate Amount(Rs.) EMB Mtrs. Nos. No. Page Total(Rs.) Total Value of the material installed. Rs.______________________ Labour Charges Rs.______________________ Departmental Charges: Rs.______________________ Total Amount debited to the estimate Rs.______________________ ix Details of PSEB/PVT. Meter installed. Meter No. Make S.No. of ME Capacity Phase Voltage No. of Digits Initial Reading ME-2 Register No./S.No. 1 2 3 4 5 6 7 8 9 Date:_______________ Signature of J.E.:________________ Name:____________________________ H. CERTIFICATE IN RESPECT OF CHECK ENTRIES TO BE RECORDED BY JE-1/ AAE/SDO Quantity of material shown as used has been measured and found to be correct except the following:- Sr. No. Item No. Shown Used Actual Measurement Difference Mtrs Nos. Mtrs Nos. Mtrs. Nos. I ii iii iv Date:____________________ Signature of JE-1/AAE/SDO Name:___________________ I. CHECK ENTERIES TO BE RECORDED BY SDC Certified that the above particulars have been checked and entries compared with IWR/ EMB. No.________________ Page_________ ME-2 Register No.______________ Sr.No.______________ Page_____________ and found correct. Date:_________________ Signature of SDC Name:____________________ (NOTE: File to be passed on to RA for allotment of Account No. and issue of provisional bill) J. ISSUE OF ACCOUNT NO. PROVISIONAL BILL AND DATA FOR COMPUTER CENTER(MASTER FILE) BY R.A. i The Consumer has been allotted permanent Account No:___________________ ii First provisional bill for Rs.____________(in words)__________________issued on date_____________________ iii Date for computer center master file: Sub-Divn. Code Billing Group Acct.No. Name of Consumer Address of Consumer Connected Load D.O.C. Tariff Type 1 2 3 4 5 6 7 8 Feeder Code Meter No Make S.No. of ME Capacity Phase Voltage No. of Digits Initial Reading 9 10 11 12 13 14 15 16 17 Date:________________ Signature of R.A. Name:_________________________ (NOTE: Case file to be sent to computer center for the preparation of Master file and issue of regular bill) K. FOR ACTION BY THE COMPUTER CENTER i Master file of the consumer has been prepared and stored. ii Regular bill issued on __________with bill group No. __________________and provisional bill of Rs.___________ adjusted. Dated:__________ Signature in charge Computer Center Name:__________________________ (NOTE: Case file to be sent back to the respective Sub-Division for Record)
