Application Form of New Electricity Connection For Industrial Use Only 1. Applicant's Name & Address 2. Name of proposed unit with address for Correspondence 3. Type of Unit / Firm / (Viz. Ownership/Partnership/ Private Ltd./ Public Ltd./Society/Govt. Deptt./ Govt. Undertaking) 4. Site Address of proposed Unit / Firm (Where Electricity Connection is desired) a) Building / Plot / Industrial Unit No. b) Locality / Industrial Estate or Area of Sector 5. Name of Institution Developing Industrial Premises (e.g. URSIDC / Self / Industrial / Deptt. etc.) 6. Possession Letter or No. Objection Certificate issued by the institution (Copy Enclosed) 7. Size Plot / Shed 8. Required Electricity Load for New Connection 9. Required Additional Electricity Load. i) Present sanctioned load No. & date of sanction ii) Required additional load iii) Present Electricity Supply Voltage iv) Whether existing supply is through an independent feeder ? 10. Whether the above unit ever operated at some other place? If yes, address of that place and details of Electricity connection : a) Sanctioned Load b) Service Connection No. c) Arrears of payment (if any) ................................................................. ................................................................. ................................................................. ................................................................. ................................................................. ................................................................. ................................................................. ................................................................. ................................................................. Post Office .............................................. Distt....................... Pin Code ................. ................................................................. No.............................. Dt.......................... ................................................................. ..................................................HP / KVA ..................................................HP / KVA ................................................................. .................................................. HP / KVA .........................................................Volts Yes No ................................................................. ................................................................. ................................................HP / KVA ................................................................. ................................................................. 11. If there existed in the past any Electricity connection in the premises where connection is being requested, If yes, details of Electricity Connection : a) Name of Unit ................................................................. b) Service Connection No. ................................................................. c) Arrears of payment (if any) ................................................................. (Contd. -2) (.... 2 ....) 12. Purpose or process for which Electricity load is required ................................................................. 13. Nature of Process Continuous / Non-continuous 14. (a) Registration No from Deptt. of Industries UA Govt. ................................................................. (b) No Objection Certificate number with date from Pollution Control Board (Copy to be enclosed) ................................................................. 15. Name of the Agency financing the Unit UPFC/ PICUP/ Banks / Self ................................................................. 16. Proposed date from which production is likely to start ................................................................. 17. Is there any other industrial unit operating ................................................................. in the vicinity of applicant. If yes, please ................................................................. give name and address ................................................................. 18. Place, Voltage Ratio & Capacity of the nearest ................................................................. Electricity Sub Station and its distance from ................................................................. the unit. ................................................................. 19. Name of Electricity Distribution Division/ ................................................................. Office of UPCL in whose jurisdiction Urban Distribution the unit shall fall. Division.................................................. Dated Signature of Applicant Office Seal / Designation DECLARATION I/ We herby declare that all the information given by me/ us as above are correct to the best of my knowledge and belief and no facts have been concealed by me/ us. I/ We also declare and agree that in case any of the above information is found to be false, Uttaranchal Power Corporation Ltd, Dehradun shall have the right to deny electricity connection at the above premises or disconnect electricity connection even if given on the basis of the above information. Place: Signature Dated: Name of Consumer / Applicant
