Form-1
(Please attach suitable value stamp paper as required under Rajasthan Stamp Act)
Application cum agreement form for new electric connection (including single point connection), temporary/permanent connection and other miscellaneous activities such as load extension/reduction, Name Change, transfer of connection, shifting of connection, change of category and electrification by developer.
The Assistant Engineer (),
Ajmer Vidyut Vitran Nigam Limited,
(Residence, Office, Shop, Hotel/Restaurant, Hospital, Theatre, Mobile tower, Telephone exchange, Education Building, Workshop, Agriculture Pump set, Public street lighting, Drinking water supply, Flour Mill, Factory, Hostel, Township, Group housing, Industrial Complex, Multi story building/complexes developed by developer, E.V. Charging Station etc.)
| Domestic service | Non domestic service | Public street lighting service |
| Agriculture service | Small industrial service | Medium industrial Service |
| Large industrial Service | Bulk supply for mix load | Temporary supply |
| Any Other category (Please specify): | ||
Note: Single phase supply shall not be admissible where motive load is more than 3 BHP.
| A/C No. | K. No. | |
| Existing | To (New) | |
|---|---|---|
| Connected load (kW) | ||
| Contract Demand (kVA) |
| Account No. | K. No. |
| From | To |
|---|---|
| Account No. | K. No. |
| From | To |
|---|---|
| Account No. | K. No. |
| From | To |
|---|---|
| Account No. | K. No. |
| From | To |
|---|---|
(vii) Other Misc. services such as meter/service line shifting, overhead line/cable shifting, transformer shifting etc.
(viii) Electrification of housing colonies/township/group housing/industrial complexes/multi story buildings/complexes developed by developer.
(ix) Single point connection.
| Bank Name | Type of account (Saving/Current) | Account No |
|---|---|---|
| IFSC Code | Branch Name | Branch address & Pin code |
| Residence/Building | |||
|---|---|---|---|
| Constructed area (sq.ft.) | Land area (sq. ft.) | ||
| Village | District | ||
| Agricultural Land / Shop | |||
| Situated at | Khasra No. | ||
| Factory building | |||
| Situated at | District | ||
13. Any electricity dues outstanding in Licensee's area of operation in consumer's name: Yes / No
14. Any electricity dues outstanding for premises for which connection is applied: Yes / No
15. Any electricity dues outstanding with the licensee against any firm with which the consumer is associated as an Owner, Partner, Director, or Managing Director: Yes / No
(For questions 13, 14 & 15, if the answer is "yes" in any case, please provide details on a separate sheet.)
16. Documents required - As per Checklist attached with the application.
17. *Details of Installation:
| S.No. | Description of Load | Nos. | Wattage/HP of each | Total Wattage/HP |
|---|---|---|---|---|
| A. Light & Power Load | ||||
| 1. | CFL/LED | 15/7 W | Watts | |
| 2. | Bulb/Fan | 60 Watts | Watts | |
| 3. | Tube Light | 40 Watts | Watts | |
| 4. | Light Plug (5 Amp.) | 60 Watts | Watts | |
| 5. | Television-Colour / B&W | 100 / 60 Watts | Watts | |
| 6. | Power Plugs (15 Amps.) | 500 Watts | Watts | |
| 7. | Fridge | 250 Watts | Watts | |
| 8. | Desert Cooler | 250 Watts | Watts | |
| 9. | Geyser | 1500 Watts | Watts | |
| 10. | Air-Conditioner 1/1.5 Ton | 1500/2200 Watts | Watts | |
| 11. | Water lifting pump | 180/360 Watts | Watts | |
| 12. | Any other motive load/device | |||
| Total | ||||
| *Total connected load: .KW/HP | ||||
| (a) *Connected Load for sanction: .KW/HP | ||||
| (b) *Contract demand: kVA | ||||
18. *Refer checklist/guidance sheet enclosed with the application form to calculate the applied connected load/contract demand.
(i) I/We hereby agree to deposit with the application, the charges as prescribed in Supply Code/TCOS.
(ii) I/We further require the Nigam to supply me/us necessary meters for measuring the quantity of electrical energy supplied and meter box. I/We shall be solely responsible for any loss or damage to the Nigam's Meters and other apparatus installed at my/or premises. (Strikeout incase applicant wants to provide his own meter).
(iii) I/We also undertake to take from the Nigam, the supply of electrical energy for my/our bonafide use for a period not less than one year from the date of commencement of supply(in case of temporary supply, for a period ) and I/We here by further agree to pay for the said supply at the tariff in force from time to time & also to pay all such other charges as become due by me/us from time to time in accordance with the provisions contained in Nigam's Terms & Conditions for Supply of Electricity or any other Rules & Regulations.
iv) I/We agree and shall have no objection at anytime to the rights of the Nigam to supply electricity to any other applicant from the service line or apparatus installed on my/our premises.
v) I/We agree not to use electrical energy during the restricted hours intimated by the Nigam.
vi) In the event of this connection being given, this application shall be treated as an agreement for the connection with effect from the date the connection is given till such time as it is either replaced by fresh agreement or it is terminated as per the provisions of Terms & Conditions for Supply of Electricity.
19. The applicant shall submit self certification/ installation certificate of the installation/ permission of electrical Inspector as per provisions of CEA Safety Regulations.
20. For HT category, the applicant shall execute an agreement with the Nigam separately in Annexure-3, as and when asked to do so.
21. This agreement shall be read and construed as subject in respect to all the provisions of Terms and Conditions for supply of Electricity and Tariff for supply of Electricity as en forced from time to time, which shall constitute a part of this agreement. The relevant provisions of the Electricity Act, 2003 and the rules and regulations made there under or any subsequent amendments or modifications thereof, shall be the governing provisions.
I/We understand that submission of any wrong information in this application, shall make the agreement itself liable for cancellation and connection if released, shall also be disconnected forth with on this ground alone.
22. As a prosumer I/We agree that I/We shall also be governed by the provisions contained in other relevant Regulations or guidelines, issued in this respect by the Commission / CEA from time to time.
Note: (i) Strike out the clause/portions not applicable. (ii) Every Page of Application form should be signed by the applicant.
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Signature of Applicant/Consumer
Address
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Signature and Address of witness
(along with K.No. if available)
Dated: .....................................
Enclosure: Check list
Accepted on behalf of the Ajmer Vidyut Vitran Nigam Limited
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(Signature)
Received the application of Shri /Ms/Messrs on for (classification of connection) along with document as per checklist and registered at Serial No. which should be quoted in all further correspondence.
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Signature & Designation of the
person receiving application
Date: .....................................
| Activity | Yes/No |
|---|---|
|
1) (a) Proof of ownership/occupancy of the premises: (any one of the following)
(b) Proof of tenant/occupier: no objection certificate of the landlord in form-A or if NOC is not available indemnity bond in form-B to be attached c) Proof of address in case of occupier or tenant having no NOC or rent deed of the owner. Proof in the form of Aadhar card/Driving License/Voter ID, Passport/Ration card or any other document for address proof as may be approved by Commission. |
|
| 2) Identity Proof- (i.e. Aadhar card/Driving License/Voter ID, Passport/Ration card or any other document for Identity proof. |
Note: Applicant shall also furnish necessary self certificate/Installation certificate in accordance with CEA Regulations.
1) Site map indicating location of the premises, metering equipments etc.
2) "Self certificate/ Installation Certificate" (may even be furnished later but before the date of deposit of demand. Cases where need of demand notice is not arising, the installation certificate should be furnished at the earliest to treat the application completed.
| 3) In case the connection is to be released on HT or EHT supply & the transformer is installed by the consumer, a permission letter of Electrical Inspectorate or the certificate of installation by a Charted Electrical Safety Engineer as per the notification of Government of Rajasthan as the case may be and can be furnished later but before the release of connection. |
| 4) Any other document. The developer need to submit the completed project report with layout of the proposed area of electrification alongwith copy of registration with RERA. Similarly for single point connection the applicant should furnished the completed data of the beneficiaries alongwith layout of the proposed area. |
| 5) Form A & B are attached herewith for release of connection for tenant/occupier, and form C for agriculture connection. |
| 6) In case of a partnership firm - The applicant shall furnish the partnership deed and an authorization in the name of the applicant for signing the requisition form and agreement; |
| 7) In case of public and/or Private limited Company - The applicant shall furnish the Memorandum and articles of Associations and certificate of Incorporation along with an authorization in the name of the applicant for signing the requisition form and agreement; |
| 8) In case of Non-Domestic Thadi and Temporary structure; No Objection Certificate for Thadi or temporary structure from the Nagar Nigam / Nagar Palika / Nagar Panchayat / gram sabha/ gram panchayat /land development authority / land owning agency. |
| 9) BPL/Astha card Category Consumers: BPL/ Astha card issued by the appropriate State Government Authority. |
| 10) In case of change in name to other than legal heir: No Objection Certificate from the existing consumer if available /possible and registered sale deed / lease deed / succession certificate / (if any other document, please specify). |
| 11) In case of change of name to legal heir: Registered deed /succession or legal heir certificate /mutation deed / (if any other document, please specify), and NOC from other legal heir(s) in case the connection is to be changed in the name of one of the legal heirs. In case the existing consumer is deceased, death certificate is required. |
The connected load for all purposes shall be determined as under:
| 1. | CFL/LED | 15/7 Watt or actual rating |
| 2. | Bulb / Fan | Actual rating or 60 Watt each, if it is not possible to read the rating on the bulb / fan. |
| 3. | Tube Light | Actual rating or 40 Watt each |
| 4. | Light Plug | 60-Watt each upto three plugs and extra 60 Watts for every three plugs or less. |
| 5. | Television | (a) Colour: 100 Watt (b) Black & White: 60 Watt |
| 6. | Power Plug | 500 Watt each up to three plugs and extra 500 Watts for every three plugs or less. |
| 7. | Fridge | 250 Watt |
| 8. | Dessert Cooler | 250 Watt |
| 9. | Geyser | 1500 Watt or actual rating |
| 10. | Air-Conditioner 1 Ton/1.5 Ton | 1500 Watt/2200 Watt |
| 11. | Water lifting pump | 180 Watt or 360 Watt (According to Pump) or according to the equipment's original rating (Name plate & Specification). |
| 12. | Any other motive load/device | Rated capacity or as per testing |
Note:
(समय समय पर राज्य सरकार द्वारा निर्धारित मूल्य के नॉनज्यूडिशयल स्टॉम्प पेपर पर)
यह प्रमाणित किया जाता है कि मैंने यह (स्थान का पूर्ण विवरण) जोकि नगरपरिषद / अन्य स्थानीय निकाय में स्थित है मैसर्स / श्री निवासी को किरायेपर दे दिया है तथा उक्त भवन में विद्युत कनेक्शन देने पर मुझे आपत्ति नहीं है।
मैं इस बात की गारन्टी देता हूँ कि जब भी किरायेदार मकान / दुकान / खाली करेगा तो इस बात का पूरा-पूरा ध्यान ररूँगा कि निगम की राशि बकाया न रहे।
ऐसा न होने की स्थिति में मैं स्वंय निगम की बकाया रकम को देनदार रहूँगा।
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हस्ताक्षर किरायेदार
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साक्षी
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हस्ताक्षर मकान मालिक
(समय समय पर राज्य सरकार द्वारा निर्धारित मूल्य के नॉनज्यूडिशयल स्टॉम्प पेपर पर)
जैसा कि मैं पुत्र / पत्नी श्री उम्र वर्ष निवासी ने सहायक अभियन्ता अजमेर वि.वि.नि. के कार्यालय में विद्युत कनेक्शन हेतु आवेदन किया है।
जैसा कि स्थित मकान / दुकान को मेरे अपेक्षित विद्युत कनेक्शन के लिये मकान / दुकान मालिक की सहमति माँगी है।
जब कि मैं मकान / दुकान मालिक का सहमति पत्र प्रस्तुत करने में असमर्थ हूँ।
चूँकि जयपुर / अजमेर / जोधपुर वि.वि.नि.लि. ने इस सम्बन्ध में मुझसे लिखित वचन चाहा हैकि अगर मैं और मकान / दुकान मालिक के मध्य इस विद्युत कनेक्शन के सम्बन्ध में किसी न्यायालय के समक्ष विवाद उत्पन्न होता है तो निगम इस मामले में शामिल नहीं होगा फिर भी निगम को इस कारण हुई किसी भी प्रकार की क्षति/खर्चों की क्षतिपूर्ति करने का मैं वचन देता हूँ।
अतः यह अनुबन्ध मकान / दुकान मालिक की बिना सहमति के निगम द्वारा मुझे उक्त परिसर में कनेक्शन दिये जाने हेतु साक्ष्य किया जाये।
मैं वचन देता हूँ कि निगम को इस सम्बन्ध में हुए वादकरण के कारण हुई सभी प्रकार की हानियों / क्षतियों एवं खर्चे की क्षतिपूर्ति का वचन देता हूँ।
स्थान: .....................
दिनांक: .....................
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(निष्पादक के हस्ताक्षर)
साक्षी का नाम: .....................
पता: .....................
मैं/हम सुपुत्र / सुपुत्री / पत्नी श्री जाति निवासी ग्राम / शहर शपथ पूर्वक बयान करता हूँ/करत हैं कि मेरा / हमारा कुआँ ग्राम के भूराजस्व क्षेत्र में स्थित है तथा मेरा / हमारा कुआँ / बोरिंग राजस्व अभिलेख के अनुसार खसरा नं० में स्थित है और यह खेती के कार्य में ही उपयोग में लिया जाता है।
इस कुएं व खेत का मैं / हम स्वंय ही मालिक हूँ हैं।
इस शपथ पत्र में उल्लेखित कोई भी तथ्य गलत पाया जाता है तो उसकेलिय मेरी / हमारी जिम्मेदारी रहेगी।
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आवेदक के हस्ताक्षर