Con No Connected load ...................

kW

For Office
Use Only
Purpose Tariff Date of Connection
Affix recent Passport size
Kerala State Electricity Board Limited Photograph of applicant /
(Registered Office: Vydyuthi Bhavanam, Pattom, Thiruvananthapuram – 695 004 authorised signatory
Website: www.kseb.in CIN: U40100KL2011SGC027424)

Application for Low Tension Connection (for Connected Load based Billing)

App No. 2166402100002 Ele. Section Ramanthali

Name of applicant (in Capital Letters) SANTHA

1 If connection is Name of Organisation
required for an
Organisation Designation of Applicant
Address of premises where electricity
Present address (for communication)
connection is required
Name of Building EDACHERIYAN
Building Number 7/408
2 Lane / street PARATHIKKADU
Place / Land mark PALAKODE
District / Pin Code KANNUR 670305
Village/Survey No. Ramanthalli 223/110 Ph (L) 0
E mail [email protected] No (M) 9496011134
Domestic ✔ Construction
5
Connected Load
Commercial
(kW) 0.14
Non Commercial
Purpose of Industrial If non domestic, provide details of
3 PAN No (Optional)
Supply (√) activity / manufactured product 6
Agricultural Domestic
Temporary AADHAR No (if available, proof of Identity is not reqd)
7
4 Status of applicant Owner ✔ Tenant
Whether other properties Yes If YES, whether consents Yes Whether internal distribution Yes
8
need to be crossed over No ✔ obtained in all cases No is carried out by promoter No ✔
If applicant desires a particular Date of Inspection, specify the Date*
* (This may attract additional expenses)
Preferences No of Phases Required (1 phase / 3 phase) 1 Ph ✔ 3 Ph
9 of applicant
(Optional) Whether consumer opt to purchase meter (as per CEA approved specification) Yes No ✔
Whether applicant wishes to remit security deposit and expenses for
connection along with application (Only for WP service not requiring poles)
Yes No ✔
SANTHA
I, ………………………………………………………………, son/daughter of ……………………………………………… hereby declare
that I have attained 18 years of age, that the information provided in this application is true to my knowledge, that the internal
RAMACHANDRAN. T.V
wiring of the premise has been tested by ........................................................................................................................................... (name of
CC2394
licensed wiring contractor) who is having a valid License No .......................................................................................................... and the
107-12/2020
test cum completion certificate / Energisation Approval No ......................................................................................................................... is
available with me. I further confirm that there are no orders of Court / Govt restricting electricity connection in the premises, that I
will remit electricity dues during every billing cycle and also as and when demanded as per the applicable electricity tariff, and
other charges, that I will own the responsibility of security and safety of the meter, cut-out and the installation thereafter. I will not
indulge in any misuse of power and will take all necessary steps in the premises for the efficient use of power and to stop its wastage.
I have read and understood the Kerala Electricity Supply Code, 2014 and agree to abide by the conditions mentioned therein.

Date: Signature of the applicant / authorized signatory

Place: Name: SANTHA
Letter of Details of Property Crossing / Dimensioned sketch of the
Documents Proof of Identity
Authorisation Property Crossing Consents premise
attached
Please tick (√) Proof of Consent from Test Certificate of metering Others (specify)
ownership Owner equipment
 Particulars of Consents / NOCs required / produced

* Proof of ownership to be produced separately

If applicant is tenant /

I /We, …………...………....…………………...........…............….. .........................................being registered title holder(s) and

the absolute owner / joint owner(s) of property comprised in Sy No ............................ of ......................................... Village,
bearing building no. ...........................of .................................................................. (local body) do hereby give my / our consent
occupier *

to Sri / Smt ......……..................…...…………………..........., who is a joint owner / tenant / occupier of the above premise to
wire and avail service connection from KSEB Ltd in his name as consumer at the above premises. I/We shall inform KSEB
as and when the premise is vacated.

Name & dtd signature of Name & dtd signature of Name & dtd signature of
owner/ joint owner(s) first witness second witness
(i) No of properties to be crossed (ii) No of consents obtained
I / We hereby give consent for drawing electric line through my / our property mentioned below for giving
electric connection to Sri / Smt ……………………………..…………………………………………………………
Name & Address of property Signature of Property
Village Sy No
owners Owner
Consents Received
In case of Property Crossing (use separate sheet if required)

Signature Signature
Name (Witness 1) Name (Witness 2)
No Name & address of property owner Village Sy No
Consents Not Received

Space for affixing Special Adhesive Stamp worth Rs 200/-

Dated Signature & Online Registration No. 2101040943196

Name of Applicant Applicant Number 2166402100002
Ele. Section Ramanthali Printed on 04.01.2021 10:19 AM
 Acknowledgement
2166402100002
Ref No: ...............................................
SANTHA
Application of ....................................................................................(name of applicant), complete
in all respects, for a new Service Connection has been received at this office on
04.01.2021 10:19 AM
.........................................................(Date).

The above reference number is to be used for all future correspondence.

This document is computer generated, no signature is required

Assistant Engineer, Electrical Section Ramanthali

Documents to be attached
1. Proof of Identity (Electoral Identity Card/Indian
Passport/Driving Licence/Ration Card/Photo Identity Card issued by
any Government Agency/PAN Card/AADHAR Card/National Population
Register (NPR)Card/Photo Identify Certificate from Village
Panchayat or Municipality or Municipal Corporation)

2. Proof of ownership (Ownership or Occupancy certificate of the

building issued by Municipal Corporation or Municipality or
Panchayat or Township / Ownership or Possession certificate of the
land issued by competent Revenue authority / Copy of title deed
duly attested by a Gazetted Officer/ KSEB Ltd officer/ Copy of the
Land Tax payment receipt issued by Revenue authorities issued
within 1 year)

3. Sketch showing details of connected equipments, marked in

building plan

4. Proof that applicant belongs to BPL category

Ele. Section Ramanthali Printed on 04.01.2021 10:19 AM