JAIPUR VIDYUT VITRAN NIGAM LIMITED

Application cum agreement form for new electric connection and other miscellaneous activities

1. Name of Applicant (in block letters)

Father's/Husband's Name

2. Full Address of the premises

House/Plot/Shop No.

Locality

Khasra no./Street

Village

Tehsil/Town/District

Pincode

Mobile

Email ID

3. Purpose of Supply

4. Status of applicant

5. Type of Application

Type of Request

(i) New Connection

(ii) Load Extension/Reduction

(iii) Shifting of connection

(iv) Change of Name

(v) Change of Category

(vi) Transfer of connection

8. Details of Installation

S.No.	Description of Load	Wattage/HP
1	CFL/LED	7/15 W
2	Bulb/Fan	60 Watts
3	Tube Light	40 Watts
4	Light Plug (5 Amp.)	60 Watts
5	Television	100 Watts
6	Power Plugs (15 Amps.)	500 Watts
7	Fridge	250 Watts
8	Desert Cooler	250 Watts
9	Geyser	1500 Watts
10	Air-Conditioner 1/1.5 Ton	1500/2200 Watts
11	Any other Appliance
Total

Declaration

I/We hereby agree to deposit with the application, the charges as prescribed in TCOS. I/We further require the Nigam to supply me/us necessary meters. I/We shall be solely responsible for any loss or damage to the Nigam's Meters. 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 and agree to pay for the said supply at the tariff in force from time to time. This application shall be treated as an agreement for the connection.

Signature of Applicant/Consumer

Signature and Address of witness