Permanent Water Connection Service(s) Form
TATA STEEL LIMITED
1. GENERAL PARTICULARS (A)
(1.1) For Individual Applicants only
Title
Mr.
Mrs.
Dr.
Prof.
Others (Specify)
First Name
Last Name
Age
Date of Birth (dd/mm/yyyy)
Father's Name / Husband's Name
E-Mail Address
Mother's maiden Name
(1.2) For Organization / Association / Corporate Applicant’s only
Name of the Organization / Association / Group
Name of the Authorized signatory
Designation of Authorized signatory
E-Mail Address
Type of Organization
Partnership
Proprietary
Private Ltd.
Public Ltd.
FOR ORGANIZATION / INDUSTRIAL SERVICE APPLICANTS ONLY
Whether Registered
Yes
No
Detail of Project /Dept.
No. of Units
Registered Office Address
Type of Industry
Name of the Product
Production Capacity
Status of clearance from Pollution Control Authority
Detail of requirement of Water at which Water supply is required i.e. whether drinking purpose, industrial purpose, water cooler plant etc. Requirement of Water in *KL
Drinking purpose (KL/month)
Industrial purpose (KL/month)
Water cooler plant (KL/month)
Others (KL/month)
*Kl = Kilo litre
(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 above 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
(1.6) Landlord (in case of Tenant) *
Name
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
* No objection letter of Landlord along with proof of ownership of landlord/ proof of occupancy needs to be submitted. It should be a legal document.
2. GENERAL PARTICULARS (B)
Desired Category
Domestic
Commercial
Industrial
Institutional/Govt
Others (Specify)
Desired Demand (KL/month)
Plot area of premises(in sq.meter/sq.ft.)**
Area of premise(in sq. meter/sq.ft.)
Built up area (in sq. meter/sq.ft.)
Number of stories
No. of residents
Child
Adult
Please specify either of the four to mentioned below:
PAN No (if available)
Voter ID Card No (Specify)
Passport No.
Driving License No.
3. PARTICULARS FOR EXISTING WATER CONNECTION
Existing Business Partner No.
Existing Service No.(in case of existing electrical consumer)
Existing Establishment No.
Existing Consumer No.
Existing Category
Domestic
Commercial
Industrial
Institutional/Govt.
Other (Specify)
Existing Demand (KL/month)
Existing Name
Demand change (KL/month)
*Reason for demand change
Meter to be installed in existing service line (Y/N)
Yes
No
Reason for category change
Reason for name change
* In case of commercial Service Purpose to be specifically mentioned
(**) 1 Sq. meter = 10.76 Sq. ft. *** KL/month = kilo-litre/month
4. 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
Cremation Ground
Industry
Library
Pumping Station
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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