New Power Connection Service(s) Form, SK
JUSCO

1. GENERAL PARTICULARS (A)
(1.1) For Individual Applicants only

(1.2) For Organization / Association / Corporate Applicant’s only

(1.3) Complete Address of location where connection is to be provided / has been provided
Type of Accommodation Owned Rented/Leased Company Provided Government Provided
House No. / Flat No. / Holding No. / Phase No. Floor No.
Plot No. Ward No.
Street Name / Road No. / Line No. Block No.
Area Sub-Area
Police Station Land Mark
Name of the Premises (if any) City
District State
Pin Telephone No.
Mobile No. E-Mail Address
Fax    

(1.4) Complete Billing Address where bill is to be sent /is being sent
Same as connection address (If different Please specify below)
House No. / Flat No. / Holding No. / Phase No. Floor No.
Plot No. Ward No.
Street Name / Road No. / Line No. Block No.
Area Sub-Area
Police Station Land Mark
Name of the Premises (if any) City
District State
Pin Telephone No.
Mobile No. E-Mail Address
Fax    

(1.5) Permanent Address*
Same as connection address    Same as billing address    (If different Please specify below)
House No. / Flat No. / Holding No. / Phase No. Floor No.
Plot No. Ward No.
Street Name / Road No. / Line No. Block No.
Area Sub-Area
Police Station Land Mark
Name of the Premises (if any) City
District State
Pin Telephone No.
Mobile No. E-Mail Address
Fax    
(*) Applicable only for individual applicant only


2. GENERAL PARTICULARS (B)
Desired Category Domestic Commercial Industrial Agriculture Other (Specify)
Desired Load * Plot area of premises(in sq.meter)**
PAN No. (if available) Voter ID Card No. (Specify)

3. PARTICULARS FOR EXISTING CONNECTION
Existing Business Partner No. Existing Service No.
Existing Establishment No. Existing Consumer No.
Existing Category Domestic Commercial Industrial Agriculture Other (Specify)
Existing Load Existing Name
Load change Reason for load change
Reason for category change Reason for name change
* In case of commercial Service Purpose to be specifically mentioned

4. FOR DOMESTIC & COMMERCIAL SERVICE APPLICANTS ONLY
Sl. No. Details of the Apparatus No. of Points Wattage of each Voltage Total Wattage
1. Bulbs
2. CFLs
3. Tube Lights
4. Fans
5. Geysers
6. Oven / microwave
7. Heater
8. Air Conditioner
9. Refrigerator
10. Television
11. Plug        
  a)5 Amps
  b)10 Amps
  c)15 Amps
12. Lift
13. Water Pump
14. Other Specify (a)
  Other Specify (b)
  Total     KW
  Contract Demand   KVA      
(*) For Industrial applicant only (**) 1 Sq. meter = 10.76 Sq. ft.

5. Wiring carried out / certified by following licensed Electrical Contractor(*)
Name of the Firm Address
Telephone No. E-Mail Address
License No. Valid Up to
(*) Not applicable in case of License Switch over

6. FOR ORGANIZATION / INDUSTRIAL SERVICE APPLICANTS ONLY
Name of Entity Whether Registered Yes No
Registered Office Address Type of Industry
Name of the Product Production Capacity
Status of clearance from Pollution Control Authority Detail of requirement of Electricity at which Power supply is required i.e. (230 V, 440 V, 6.6 KV, 11 KV, 33 KV) Requirement of Power in KVA

7. ADDITIONAL PARTICULARS FOR SERVICE ENHANCEMENT
Education Secondary Senior Secondary Graduate Post Graduate Other (Specify)
Occupation Salary Self employed Student House wife Retired Other (Specify)
Employment Details Govt Sector Public Ltd Private Ltd Partnership Propritor Other (Specify)
Annual Income Up to 1.0 Lac 1.0 Lac to 2.5 Lac 2.5 Lac to 5 lac > 5 Lac  
Establishment
Park Public Convenience Religious Place Society / Trust
Horticulture Street Light Cremation Ground Industry
Pumping Station Sub Ways Library Stair Cases
Traction Railway Station Stadium Lawyer Chamber
Court Petrol / Gas Station Hostel Auditorium
Cinema Hall Hotel & Restaurant Retail Outlets Educational Institute
Hospital Banks Telecom Power Utilities
Central Govt Office State Govt Office Housing Complex Govt Housing Complex
Details of Family Members
Adult Child

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