FORM I (Tamil Nadu Electricity Board) Application Form for LOW TENSION Ser ice connection (e!

cept A"riculture and #ut) FORM OF RE$%ISITION FOR S%&&L' OF LOW TENSION ENER(' ( Sin"le &)a*e + T)ree &)a*e) (Refer clause 27(3) of Tamil Nadu Regulatory commission, TAMIL NAD !L!"TRI"IT# DI$TRI% TI&N "&D!, Notification No' TN!R" (D"()(* dated 2*'+7'2++,) To The Designated Engineer (Address of the Licensee) Sir, 1. I hereby require you to supp y e ectrica energy to the pre!ises hereinafter described. ("ote this underta#ing does not prec ude a separate $ritten contract being entered into, if so desired by the Licensee or the consu!er.) %. I agree to pay for said energy, ser&ice connection and other dues inc uding the deposit of such security, !eter rent, as !ay be de!anded in accordance $ith the sca e of rates prescribed under Ta!i "adu E ectricity Distribution 'ode, Supp y 'ode, notifications and orders issued in this regard by Ta!i "adu E ectricity (egu atory 'o!!ission. ). I $ish to be charged under Tariff **** under schedu e of the T"E(' tariff order dated. +. I agree to ta#e supp y for *****. years and uti i,e the energy in the pre!ises described hereunder or outside the pre!ises for !y bonafide use. -. In case I se or other$ise dispose of the property . &acate the pre!ises $hi e the supp y is continued, I agree to gi&e one 'a endar !onth notice in $riting and pay a the arrears to the Licensee. /ai ing such notice, I ho d !yse f responsib e for energy consu!ed in the pre!ises ti such notice is gi&en to the Licensee. 0. Description of the pre!ises Door "o. and . or na!e of the house or pre!ises Street To$n . &i age and Ta u# 1$ned by ("a!e in 2 oc# etters) Tenanted by ("a!e in b oc# etters) App icant3s correspondence address 4. The fo o$ing are !y require!ents (A) Li")tin" (i) Lights 7 7 7 (ii) /ans 7 7 7 (iii) 'on&enient $a p ugs 7 7 7 (B ),ome*tic electrical apparatu*8 (i)'oo#ers 7 7 7 (ii) 5ater heaters 7 7 7 (iii) (efrigerator 7 7 7 "u!ber of 6oint3s 5attage of point3s Tota $attage

(i&) Air 'onditioners (&) 1ther purpose 7 7 7 (&i) 'on&enience $a p ugs777 (-) &o.er Load* (i) Do!estic (ii) Industria (iii) 5e ding (i&) 1ther purposes (&) 'on&enient 5a 6 ugs De!and app ied for in 95 The $iring has been co!p eted on 8 Signature of the 'onsu!er 6 ace Date "ote 8 The app ication sha be acco!panied $ith the fo o$ing docu!ents8 i) 6roof of o$nership (sa e deed or property . $ater . se$erage ta: receipt) ii) 'onsent etter fro! o$ner $here&er app icab e /1( LI'E"SEE3S ;SE 1"L< App ication registered as "o. dated

"ote. 1. In case of transfer of the ser&ice, fresh app ication shou d be signed by the transferee (or a etter signed by both the transferor and transferee, agreeing to the abo&e conditions for transfer shou d be obtained). %. Additions or o!issions to the connected oad to be notified to the Licensee before effecting the e ectricity connections. 6(E'A;TI1" T1 2E AD16TED 2< '1"S;=E(S, 15"E(S ELE'T(I'AL '1"T(A'T1(S, ELE'T(I'AL 51(9=E", A"D 1T>E( S;66LIE(S 1/ E"E(?< "o e ectrica insta ation $or#, inc uding additions, a terations, repairs and ad@ust!ents to e:isting insta ations e:cept such rep ace!ent of a!ps, fans, fuses, s$itches and other co!ponent parts of the insta ations as in no $ay a ter its capacity or character sha be carried out upon the pre!ises or on beha f of any consu!er or o$ner for the purpose of the supp y of energy to such consu!er or o$ner, e:cept by an authori,ed person specified by the Authority.