Temporary 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 / 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.
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) 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
* 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. PARTICULARS OF TEMPORARY CONNECTION
Purpose *
From Date
To Date
Demand Requirement (**KL)
*
In case of Commercial Service Purpose it is to be specifically mentioned.
**Kl = Kilo liter
3. EXTENSION OF TEMPORARY CONNECTION
Extension No.
From Date
To Date
Reasons for extension
4. PARTICULARS FOR EXISTING CONNECTION IN CASE TEMP WATER 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
Institutional/Govt
Others (Specify)
Existing Demand (KL)
Existing Name
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