APPLICATION FORM OF ELECTRICITY CONNECTION FOR INDUSTRIAL USE ONLY
| 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 |
|
DECLARATION
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.
| Dated: |
Signature |
| Place: |
Consumer/Applicant |