Application form for new Low Tension (LT) connection

Unique Business Identification Number

Please Specify Your UBIN: *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

General Information

Required Power (in KW) : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Consumer Category :

Service Requested :

Company Name : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Name of the Applicant : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address of the Applicant

House No/ Plot No. : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Road : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Town/Village:

Country *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

State *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District

Pin code : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Mobile Number: *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address of the enterprise at which supply is required

House No/ Plot No. : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Road : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Town/Village:

Country *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

State *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District

Pin Code: *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Mobile Number: *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Existing/ Nearest Consumer Number :

Electrical Subdivision *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Billing Details

Street name 1 : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Street name 2 : *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Town/Village :

Country *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

State *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District

Postal / Zip Code *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Mobile Number: *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Type of Premises :

Dag No. :

Mouza No. :