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The Assistant Engineer (),
Jodhpur Vidyut Vitran Nigam Limited,

(i) New Connection: KW / KVA

(ii) Load Extension/Reduction

	Existing	To (New)
Connected load (kW)
Contract Demand (kVA)

(iii) Shifting of connection

(iv) Change of Name

(v) Change of Category

(vi) Transfer of connection

6. Details of my/our property, If person(s) do not posses any such land/ property, a 'Nil' may be mentioned against that.

Residence / Building

Constructed area (sq. mtrs)

Land area (sq. mtrs)

Village

District

Agricultural Land / Shop

Situated at

Khasra No.

Factory building & machinery

Situated at

District

7. Documents required - As per Checklist attached with the application.

8. Details of Installation:

S.No.	Description of Load	Nos.	Wattage/HP of each	Total Wattage/HP
A. Light & Power Load
1.	CFL/LED		7/15 W
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.	Any other Appliance
Total
Total connected load: .KW/HP
(a) Connected Load for sanction: .KW/HP
(b) Contract demand: KVA.

Note:
(a) If any equipment is connected with plug point, equipment's load or plug point rating, whichever is higher shall be taken. In such case, load of plug point shall not be counted separately.
(b) The higher rating of only one equipment shall be considered if both geyser and air conditioner are installed.
(c) Load of fire protection equipments shall not be considered for assessing the connected load.

9. (i) I/We hereby agree to deposit with the application, the charges as prescribed in 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 in case 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 hereby 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 -2004 or any other Rules & Regulations.

iv) I/We agree and shall have no objection at any time 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 connect ion 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-2004.

10. The applicant shall submit self certification of the installation/ permission of electrical Inspector as per provisions.

11. For large industrial category, the applicant shall execute an agreement with the Nigam separately in Form-II, as and when asked to do so.

This agreement shall be read and construed as subject in respect to all the provisions of Terms and Conditions for supply of Electricity-2004 and Tariff for supply of Electricity as enforced 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.

Note:
(i) Strike out the clause/portions not applicable.
(ii) Every Page of Application form should be signed by the applicant.

Enclosure: Check list

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Checklist for completed Application Form

#	Activity	Yes/No
1)	Proof of ownership of the premises: - (any one of the following documents to be provided for either Owner/Tenant Or Occupier) a) In case of Owner of the Premises (any one of the following documents) Title Deed (Registry); OR Possession letter issued by Local Bodies or any other Government authority like RIICO, Industries Deptt. etc.; OR In Rural areas, the certificate issued by Revenue authorities; OR Partnership deed; OR Patta; OR Sale deed: OR Allotment letter; OR Court order; OR Any other document (specify); OR b) In case not the Owner of the Premises - Proof of tenant or occupier: (any one of the following) Rent deed/ consent of owner on Non-judicial Stamp paper worth Rs.50/-; OR Indemnity bond on Non-judicial Stamp paper worth Rs.500/- in case there is no consent of owner.
2)	Authorization Document or ID and address proof: (any one of the following documents to be provided) Authorization Document issued by the competent authority (in case of Firm/ Company); OR Voter ID/ Ration Card/ Adhar Card/ Bhamashah Card/ Passport/ Driving License (In case of individual applicant)