PUNJAB STATE ELECTRICITY BOARD APPLICATION AND AGREEMENT FOR (For Loads up to 100 KW) PSEB CS-I Sr. No....(to be machine numbered) For Official use only 1. Name of Sub division_________________ 2. Applicants Name/Designation____________________ 3. Is applicant a member of Scheduled Caste/Back ward Classes ___________ 4. Security Receipt No. and Date ____________________ 5. Current Account No. (If any) ______________________ 6. a) Present connected Load (if any) ________________ b) Load applied ___________________ c) Total Load _____________________ ....................................... (To be completed and signed by Applicant) To The__________________ Punjab State Electricity Board, ________________________ I/We hereby agree to take from Punjab State Electricity Board (herein-after 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 Advance Consumption Deposit as per the provisions of Conditions of Supply of electric energy by PSEB and Schedule of General Charges. And I/We hereby declare that the said conditions of supply including Schedules of Tariffs and Schedule of General and Service Charges have been perused by/read to me/us and I/We agree to be bound by them as also the provision of the Indian Electricity Act, 1910 and the Electricity (Supply) Act, 1948. I/We further require you to supply me/us with the necessary meter/meters on hire in terms of Section 26 of The Indian Electricity Act, 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. Description of Premises:- house/ship/premises No......Locality........Town/Village..... I/We also declare that I/We am/are owner/landlord of the premises or my/our/landlord/owner agrees to my/our taking the said supply and his/their written consent is attached herewith. 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 herby agree to keep the PSEB 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 of this electric connection by the PSEB to me/us. 2. I/We hereby agree that I/We shall abide by the power cut restrictions/peak load hours restrictions imposed by the State Govt./Board from time to time as per the provisions of section 22 A and Section 22 B of The Indian Electricity Act, 1910. 3. It is disclosed that I/We am/are major. 4. The authorized representative of the Board can check energy consuming apparatus at my/our premises at any time. ..................................... Schedule of energy consumption apparatus: LIGHT AND FANHEAT AND Lamps, Wall Plugs and other Lighting load HEAT AND POWER Appliances, Heater, Cookers, Refrigerator and Power Plugs etc. INDUSTRIAL LOAD Motores etc.. Description No. Wattage Total each KW Description No. Wattage Total each KW Description No. HP/KW Total each KW Light Fans Wall Sockets Connected Load Connected load Connected load Total connected load........KW Signature of witnesses........Signature of Applicant....... Name............... Name............... Address.............. Present Address........... PSEB Account No........ ................ Dated................ Signature of representative of PSEB with designation. Note:- Applicant will sign in the presence of XEN/AEE/AE/JE/RA/ARA and in case of Sub-Office Addl. AE/JE. Officer will ensure that this form has been filed in correctly. He will sign after satisfying himself that form has been signed in his presence. Dated........... Signature of officer/official verifying the correctness of the application. Name:........ Designation:...... FOR OFFICE USE ONLY General Load........... Motive Load if any.......... Total connected load......... Watts/Kilowatts/LT(400 Volts)/HT (11 KV)
