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 Applicant's Name & Address _______________________________________________________
Name of proposed unit with address for correspondence _______________________________________________________
Type of unit/firm ( viz: Owners/Patrners/Private Ltd./ Public Ltd./ Society/Govt. Deptt./Govt. Underataking _______________________________________________________
Site Address of Proposed unit/firm (Where electricity connection is desired  _______________________________________________________
Building/Plot/Industrial Unit No. Post Office______________________________________________
Locality/Industrial Estate/Area/Sector Distt. __________________ Pin Code ___________
Name of institution developing industrial premises (e.g. UPSIDC/SELF/INDUSTRIAL DEPTT Etc) _______________________________________________________
Possession letter or No. objection Certificate issued by the institution (Copy enclosed) No.______________________ Date_________________
Size of Plot/Shed _______________________________________________________
Required Electricity Load  (New connection)  _______________________________________________________H.P./KVA
Required additional electricity load  
Present sanctioned load No. & date of sanction. _______________________________________________________H.P./KVA
Required additional load _______________________________________________________H.P./KVA
Present Electricity supply voltage _______________________________________________________H.P./KVA
Whether existing supply is through and Independent feeder? Volts _____________________________   Yes/No.
Where the above unit ever operated at some other place? If yes, address of that place and details of electricity connection _______________________________________________________
Sanctioned load _______________________________________________________H.P./KVA
Service connection NO. _______________________________________________________
Arrears of payment (if any) _______________________________________________________
If there existed in the past any electricity connection in the premises where connection is being requested. If yes, details of electricity connection _______________________________________________________
Name of unit _______________________________________________________
Service connection No. _______________________________________________________
Arrears of payment (if any) _______________________________________________________
Purpose of process for which electricity load is required _______________________________________________________
Nature of process continuous/non-continuous
Registration No. from Deptt. of Industries UP Govt. _______________________________________________________
No objection certificate number with date from Pollution Control Board (copy to be enclosed) _______________________________________________________
Name of the Agency financing the unit UPPC/PICUP/BANK/SELF ........... _______________________________________________________
Proposed date from which production is likely to start. _______________________________________________________
Is there any other industrial unit operating in the vicinity of applicant? If yes, please give name and address _______________________________________________________
Place, Voltage ratio & Capacity of the Nearest Electricity Sub-station and its Distance from the unit 33/11 KVS /S 132 KV S/S
Name of Electricity Distribution Division/Office of UPPCL in whose jurisdiction the unit shall fall. Electricity Distribution Division ___________________________
Dated : .........

Signature of Applicant

Office seal/Designation



I/We hereby declare that all the information given by me/us as above are correct to the best of my knowledge and no facts have been concealed by me/us.

I/We also declare and agree in case of the above information is found to be false UPPCL shall have the right to deny electricity connection at the above premises or disconnect electricity connection even if given on the basis of the above information.





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