Temporary Power 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 / Group / Builders Applicant’s only
Name of the Organization / Association / Group / Builder
Name of the Authorized signatory
Designation of Authorized signatory
E-Mail Address
Type of Organization
Partnership
Proprietary
Private Ltd.
Public Ltd.
(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) Permanent Address of Applicant (Address for Communication)
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) 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
2. PARTICULARS OF TEMPORARY CONNECTION
Purpose *
From Date (dd/mm/yyyy)
To Date (dd/mm/yyyy)
Load Requirement
KW
KVA
HP
*
In case of Commercial Service Purpose to be specifically mentioned.
3. EXTENSION OF TEMPORARY CONNECTION
Extension No.
From Date (dd/mm/yyyy)
To Date (dd/mm/yyyy)
Reasons for Extension
4. PARTICULARS FOR EXISTING CONNECTION IN CASE TEMP POWER REQUIRED FOR CONSTRUCTION PURPOSE IN EXISTING PREMISES
Existing Business Partner No.
Existing Service No.
Existing Establishment No.
Existing Consumer No.
Existing Category
Domestic
Commercial
Industrial
Agriculture
Other (Specify)
Existing Load
KW
KVA
HP
Existing Name
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
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