PCL-LT(DS upto 20 kW) » 2) 3) 4) 5) Annexuro-"t A’ PUNJAB STATE POWER CORPORATION LIMITED saranans ‘APPLICATION AND AGREEMENT (A & A) FORM user ze For DS (Only Residential) up to 20 KW pica ‘oraory (To BE COMPLETED AND SIGNED BY APPLICANT) Name of apaeant (Sof attested copy of identity proof to be submited) a) Aadhaar Card No. Rares a) HousarPramises no 8) Steat na @)Arealeolany Ci Vilage @)_ Telephone Ne Mobi No Email Adsress Tategory Purpose of SUpRIY DS (Residential OV) ‘Schedule of electicity consuming apparatus: Category Daseription Na: Wattage | Total each | kW a) Light Ponts rani) By Fan Points ps(only | &) Wall sockets Residential) Smeg @ Power plugs ey ACs cal 250 Wate Oat 7_OtheriMotive Loads: Total Connected load (kW) Load iDeriand apolied (KWIKVA) a) Existing loadidemand Wany by Account no, @)_Adaitional loadidemand required a) Total feadidemand6) [Permanent application no7 7) [Processing fee receipt no. & date 8) [ Security (consumption) receiptno, & date 9) [Security (meter) receipt no, & date 10) | Tadieate if works are fo Be carried out by you Tor the service connection 11) Tadieate you want to instal your own meter of approved make 12)| Any electricity dues outstanding in PSPCL area Yast No of supply in consumer's name 18)| Any electricity dues aulstanding for the premises Yesi No for which connection’ additional load applied for 14)| Any electricity dues outstanding of PSPCL Yast No against any firm/company with which the consumer is associated as an Owner, Partner, Director or Managing Director NOTE : (For questions 12, 13 & 14 if the answer is ‘Yes! in any case please provide details on a separate sheet) 15) We declare on oath that a) Ie amfare major b) Ie amare the lawful owner of the premises or my/ourlowner of the premises agrees to my / our taking the said supply and his/their consent has been obtained (NO PROOF IS REQUIRED TO BE SUBMITTED) Me are the lawful occupier of the premises but it has not been possible for mefus to obtain consent from the owner of the premises and IWe hereby agree to keep the PSPCL indemnified and harmless against all ‘laims made and action and proceedings taken up by the owner of the premises or any person claiming through or under him by reason of ‘alving of this electric connection by the PSPCL to melus. ©) That all the electrical installation work within my/our premises is as per the provisions of Central Electricity Authority (Measures Relating to ‘Safety and Electrical Supply) Reg-2010 and as per relevant standards of BIS. Further, wiring has been carried out by an electrical contractor licensed in this behalf by the Government of Punjab and under the direct supervision of a person holding a certificate of competency and by a person holding a permit issued or recognized by the Government of Punjab and I/We have obtained a test report from electrical contractor in this regard and the Test Report is in myfour possession. ‘That [Me shall at all times be solely responsible for the maintenance of mylour installation in such condition as to be free from danger. ‘That [Me shall indemnify PSPCL against any loss to me/us accrued on this account. d) Ie hereby agree that We shall abide by the power cut restrictions! peak load hours restrictions. 2). There is no other electric connection running in the abave premises.or (One No. DSINRS electric connection is already existing in the above premises and We want to take second DS connection for which We are ready to comply with the conditions of the PSPCL, f) Lama Scheduled Caste/STIBCIBPL for which copy of relevant certificate is attached. 9) That the location of my premises does not fall in the restricted zone as declared by PUDA/Local Authority. h)_IMe have applied this electric connection for domestic purpose and no business actvity shall be carried out in this premises without prior approval from the PSPCL, VERIFICATION: liwe also declare that the above information is true to my /our knowledge and in case We violate any undertakinglinstructions or any other information is found to be false at any stage, my/our electric connection ‘may not be released and, if released, may be disconnected without prior notice and all charges deposited by melus be forfeited. Signature of the applicant(s) 16) We hereby request Punjab State Power Corporation Limited (herein-after referred to as the PSPCL) to give supply for load/demand mentioned in SNO.S above. IWe hereby further agree to pay for the said supply in accordance with the relevant Schedule of Tarif, as approved by the ‘Commission from time to time and also to pay all such other charges as may become due from melus. IWe also agree to abide by the provisions of Supply Code-2014, General Conditions of Tariff /Tariff Schedule Tarif (Orders and Electricity Act-2003 as amended from time to time. We further request you to supply me/us with the necessary meterimetering equipment. Me agree to deposit security (meter) and to pay monthly rentals for the meter / metering equipment as prescribed in the Schedule of General Charges {Signature of Applicant) Name. (Signature of load sanctioning authority) (Signature of officer/official verifying the with designation correctness of the application) (for and on behatf of the PSPCL) Name: Designation Date.FOR OFFICE USE ONLY 1) Name of Sub division 2) Applicants Name/Designation Signature of load 3) Is applicant a member of SC/STIBC/BPL 4) Security(Consumption) Receipt No. and Date a). Existing LoadiDemand, itany (KWIkVA) bb) Load /Demand applied (kWIKVA) €) Total Load/Demand Sanctioned (kWikva) 5) Supply voltage 6) Category of connection 7) Account no. ACKNOWLEDGEMENT Application (ABA Form) of (name of applicant) for - (purpose) is hereby received on (date). in this regard, the applicant is given a permanent A&A no. to be used for all future correspondence. Signature / Seal of PSPCL representative Name and Designation of oficial receiving the A&A FormGUIDELINES FOR APPLICANTS FOR RELEASE OF ELECTRIC CONNECTIONS / EXTENSION(s) IN| LOAD/DEMAND 1) The applicant shall sign each page of A&A form and submit the following documents, as may be applicable. a) Identity proof :Application (A&A form) for new connection shall be accompanied with a photograph and identity proof of the applicant. Any of the following documents shall be considered 2s acceptable proof of identity ifthe applicant is an individual () Voter identity card, Passport; (ii) Driving license; (iv) Ration card, (¥) Photo identity card issued by Government agency/PSU; (vi) Certincate of identity having photo issued by Gazetted officerTehsidar on letterhead: (vil) PAN card; and (will) Aadhaar Card b) Proof of OwnershipiOccupancy of Premises: The applicant shall submit proof of ownership/ ‘occupation of the premises for which the connection is applied. Any of the following documents shall Ibe acceptable as proof of ownership or accupaney of premises:~ 1) Copy of sale deed or lease deed or rent deed and in the case of agricultural connections iiy » ©) An foli 4) Cor a copy of khasra / girdawari | jamaband | fard ofthe land; Certificate from Panchayat etc. showing ownership of premises within phimilal lakir of village for DSINRS connection; )) Registered General Power of Attorney: )) Municipal tax receipt or demand notice or any other related document; Letter of allotment with possession letter, application by a Partnership firm, Company or a Trus/Society shall be accompanied by lowing documents: ‘An attested copy of the partnership deed signed by all the partners or by @ partner authorized to sign by other partners through a Special Power of Attomey duly notarized. ‘A private or a public limited company, shall while submitting an application, furnish certified copies (by the Chartered Accountant of the Company) of the resolution of the Board of Directors in favour of the person authorized to sign the A&A form and other documents. The signatures of the authorized signatory shall also bear the common seal of the company. In case of change in the Board of Directors, the consumer shall intimate the Distribution Licensee (PSPCL). ‘An application by a Trust or a Society shall be accompanied by a certified copy of its Constitution, is bye laws along with resolution in favour of the authorized signatory for signing the A&A form and ather dacuments. The names of the managing body of the Trust fr Society and their residential addresses shall also be furnished. The consumer shall intimate to the Distribution Licensee (PSPCL) every change in the managing body of the Trust or Society within one month, rlifcate from Sub Divisional Magistrate /Sub Divisional Officer (Civil) / Revenue Officer concerned regarding member of SC/ ST/ BC / BPL.2 3) 4) 5) For release of new connection/additional load/demand an applicant shall submit No Objection Certificate (NOC) from the competent authority in case it is required as per any State/Central government law/notified policy or regulations framed under the Electricity Act, 2003 or specific order ‘of any court issued from time to time restraining release of connections in any particular arealpremises. The Distribution Licensee (PSPCL) shall circulate the list of cases where NoC is, required, as per applicable law/policy, with the approval of the Commission, The application and agreement form duly filed in shail be submitted to the Consumer Clerk (CCV (RA) for further process. RA shall give details of amount on account of Security (consumption) and Security (meter) etc, to be deposited by the applicanVconsumer with the cashier. Connected load may be determined as per table given below and complete detail shall be given in the test report to be submitted at the time of compliance of demand notice. Category | Light | Fan point | Wall Power Air point socket | socket Conditioner {Single phase) DSIBS (DS | Actual or | Actual or [Actual or [Actual or | Actual — or purpose) | 40 Watts | 60 Watts | 60 Watts | 1000 Watts | 2500. Watts {half to | (one third | (one fourth | (one fourth | (half tobe be tobe to bel to be | counted) counted) | counted) counted) | counted) » NRE ‘Retual_or | Actual or | Actual or | Actuator |AS par Industria | 40 Watts |60 Watts | 60 Watts | 1000 Watts | name plate BS (NRSI | (all to be | (all to be | (one third | (half to be | (all to be Industrial" | counted) | counted) | {5" be | counted) | counted) purposes)! counted) AP High Tech. a) Three phase power sockets for NRS/Industrial purposes shall be taken as 6 kW each and half of the no. of sockets shall be counted. b) Any fraction of lamp / fan/socket/ AC shall be counted as one. ©) Either the standard wattage of the electric switch/plug/power plug or the load actually connected to such electric switch/plug/power plug shall be considered for calculating the connected load. d) Incase a single switch Is used for controlling more than one lamp/appliance, the sum of the total capacity of all the lamps/ appliances shall be taken into account for computing connected load, fe) The load of air conditioners/AC packagesicentralized AC systems bearing ISI mark/star labeled shall be taken as per their nameplate. For non-standard 1.5 ton ‘window/split air conditioners, the load of each shall be taken as 2.5 kW. f) The load of three phase power plugis) used for equipments temporarily connected for the maintenance and operation of a green house under AP High Technology category shall be considered as 6 kW per power plug.