Serial No.

:
TATA POWER-DDL
TATA POWER DELHI
(A Tata Power DISTRIBUTIONTED
and Delhi Governiment Joint Ve
ATTRIBUTE CHANGE FORM
Nottaton No: olozoaLls |3|]44
To
HOG (CMG)
Tata Power Delhi Distribution Limited
CENCARE Building, Opposite C-2 Block,
Lawrence Road, keshavpuram, Delhi-110035
Subject : Request for Change inName Category] Load Enhancement Load Reduction
GST No. PAN No.
"(GSTIN no. is mandatory to obtain input tax credit on GST paid.) (For correct deduction of TDS, if any)

against CA No 6 o 4 3T|2|4] Required Meter TypeJSingle Phase Three Phase

Meter No.
Reading
Having Supply Address
Dear Sir/ Madam,

Kindy providefolowing changes inattribute against the above mentioned CA NO, as per the following details, The necessary charges
for this as approved by Delhi Electricity Regulatory Gommission may ploase be lovied in my next electricity bill or be raised by means
of a separate Demand Note.
ATTRIBUTE
CHANGE REQUIRED EXISTING AS REGISTERED IN TPDDL RECORD BEING APPLIED BY CONSUMER
SANCTIONED LOAD
J(Kw(KVA) oS(KwVA)
SANCTIONED
GATEGORY

NAME (As per RIA NDE R AKES

ownership proot DD
in Capital Letters)
SANGH |AlS HOTsHIM
At any stage. Hany ofthese
transferring/adjusting past dues
dues /orliabilities
liabitiesagainst
are detected againstconsumption
my monthly the above mentioned CA NO. Ihave
bill and Iundertake to paynothecbjecion to TPDDL
same within their
respective due dates.
Ihereby indernnify TPDDL against all proceedings, claims, demands, costs, damages, expenses that may be incurred by
reason of the above mentioned attribute change services against above mentioned CA NO. All the charges to this account shal
be included in next electricity bill or raised by means of Demand Notes as per the regulations. In the event of non-payment, it
could be treated as defaut and TPDDL will have the right to take appropriate action including disconnection. lalso decarethat
lam the lawful occupant of the above mention premises and understand that TPDDL has every right to disconnect the supply
without any notice on account of any details / documents provided by me proves to be false /incorrect at any stage.
Ihereby undertake to installEarth Leakage Protection Device (ELCB)of an appropriate rating before geting the meter installed
(it not already
voltage installed),
installations, failure
of 5KW andwhereof, shallTPDDL
above) and be construed as violation of Rule 61A of indian Electricity Rules. 1956for low
shall have absolute right to refuse
the time ELCB has been installed by me. installations of the meter applied for, till
Thanking you,
Yours faithfully,

Signature of Applicant : Signature of Official

Age of Applicant Name of Official
Mobile No, Employee No.Location
E-mail Date
CNNo - tLAO109DL2001PLG111526, E-mail :tpddla tatapower-ddL.com Wabsite :
ww.tatapower-dd. com
 Declaration
Raked -23L Vihftanhuhn
Son/paughter/Wife of
Re sidenf of
hereinafter refdred to as 'Applicant. which term shall mean and
incluct exectors, afmiistralo.heirs, successdra and assighs), do herdby sweat and declare as under.
a company incorporated under the provision of the Companies Act, 1956 Or as amended. having its
(hereinafter refferod to as "Applicant which expression shall. unless
registerod office at
reouguBnttothe context of moaning thereof, incude
hereby swear and decare as under
its successors and assigns), through its Authorised representative Mr.
hereinafter referred to as the
Asole proprietorship/a partnership firm having ts offlice at
applicant which unloss the context otherwise providos includes its succossors and assigns), through Me
who is a partnor or an authorized representative do hereby swear and dedare as under.
(herenaer the "Prenises)
That the Applcant it a lawful occupant of the prornises at
That the Applicant has requostod the Licensee to provide a servioe connection at the above-nentioned orernises in the Applicant's nane for the purpase mentioned in the
application forn.
That in furniahing the present Declaraton, the Applicant has cleartly understood that shodd arny of the staterments in this declaration prove to be false or incorecyater
stage, the Lioansee shal be within his lawful nght to dsconnect supply to the promises without any prior notoe and proceed to adjust electricty supp'y dues payabile by the
applicant against consumer security deposit and/or recover the same in accordance with Law.
That the Applcant has complied with all requirements under all statute for the tirme being in force and the apolcant himsolitfhersetf shall be held legally responsible for any
issue arining out of any such noncompliance for whilch the Llcensee may initlate action in acoordance with applicable Law.
That 1, the Applicant hereby agrees and undertake:
That in case the Applicant is not the soe ouner of the promises, no objection cerificate for seeking electriciy connection fromthe co-owner has been
oblained.
2 1o oemny o tcensee against al proceedings, claims, demands, costs, damages, expenses that the Licensee may incur by reason of a fresh
3. That to the best of applicant's knowodge, al electrical works done within the premisen are as per Central Electricity Authority (Measures relating to
salety and Electricity Supply) Regulations, 2010 as amended from time to time.
iicate is available with the applicant.
5
That the intornal wiring at tho promisos has been tested by alcenod electncalcoao
0)does not exceod 15(heen) meters on the date of seeking sersce connection: Or
(1)hat lamore
there is than 15 (ifteen)
a provision of i meters andand
in prernise fire clearance certificate
the applicant is avalable
has obtained the iftwith the certifcate
ftness applicant from the Electrical Inspector for the lift in the said

7 That the apolcant has apolied forthe correc category of taritf as per the applicable tariff schedule. For either of the following categories of connection,
the applicant has the relevant documents available with him,

"Applicant for selected consurmer category

a) Industrial
Valid industrial LicenseFactory Llcensel.al Dora Certificate is case of rursi village
b)
Certifcate of Residence From Block Developmeni Dck Denleerment Offcer Delhi Jal
O
Uhon certincate from Development Cotmissioner Board for tutbe wels.
c) mnstie
Non-domestir Recelct Number Ueture
No Objection Certlicata for khokha/Tomporary Structure for single delvery supply
d) Churoinc
An undertaking by the applicant that the charging station for electric vehicles is as per the specifications as may be specifid by Central Electricity
Authority or Bureau of lndian Standaros o d lots are muailable wth me and can be inspected by the Llcensen at any
ie lo cae of anyfare to produCo the same, the Licensee may disconnect the connection granted owing to such failure roluctanco on my part to
producelallow the inspection of sald documents /Certificates
That fwl provide acopy of any of above applcable documents to the Licensee gursuant to request of arny external goverment agency, judicial forum
10 That my industry /trade has not been declared to be releasing obnoxious hazardousipollutant by any government agency and that no orders of any
court of judicialsuthority wiould be breached by running of my industry Itrade or granting any eleciricity connection to ihe same. The Licensoo is
Te Asclicantfurther arees to indemnity and hold harmless, the Licensee, in caseof arny injury or incident on account of anyfault in electricity work in
the premises. The Licenseo shall not be liable for ary mishap or incident occuring at the premises to the applicant on account of any
fauityldefecticefinferior quaiy wng charnes at the rates set out n tho Licensoe's Taritf Schedule and miscellaneous charges for supply
12
ein force from tirme totime regularly as and whern the same becomes due for payment.
13, To deposit the additional security deposit and addiional service line cum development (StLD) charges, f any from time to time based on the prevailing
14. To nhlde hw the proelon ofthe ElectrlcityAct, 2003 al applicable laws, conditions of Supply/Tarit Orders and any other Rules or Regulations as may
be notified by the Commission, as appicattieb eonsmntion, chaeoes duyeloutctanding along wth eny other charge against the Consumer
15
the Annant in the event of termination of the agreerment prior to expiy of the contracted period or lin caso of any contractual
dtadh Ne per orovinions of regulationsirules/orderdirectonso e nded trom tlme to tirne, l shall provide suitable arnd
That as per Delh Electricty Sup oe ctclly auoments where te Lcensoe may hav ready acoess to the same
To allow clenr and un-enc imbered access to the meters for the purpose of nce in the eventof any detault. non-complance of statutory
at n vet of a logaly bincding drective by Statutory Authority (es) to effect such an order. This shal be without prejucdice to any other
right of the Llcensee inclueng Cieeuslt Breaker deyice/ELCBVMCB for sinale phase connection &4 pole
1
MCCBIELCB/RCCB for three phase connection before using power supply service at my aforesald premises where electricity connection
has beer sought. I too declare that, earthing is done at applied premise and equal load is distributed on all phases. On etc.my failure to install
at the aforsaid
ATADn hiall be free to procend with cancelation o electriciy connection and econn te
20 All the above declaration given by the Applicant shall be construed to an Agreement between the Licensee and the Applicant.

Signature of the Applicant SIGNED AND DELIVERED

Name of the Applicant In presence of witness
Name of witness
*Select whichever is applicable