ONLINE NEW CONNECTION SERVICE(S) FORM

REQUEST NO : ONNFC2312241918

Consumer Information

Consumer Type

Individual

Title

Mr.

First Name Middle Name Last Name

MOHD Middle Name... SALAMUDDIN

Son Of Daughter Of Wife Of Care Of

Father/Husband/Guardian's Name Primary Contact Number

MOHD SAMDANI 9560621231

Address
Unique Property Identification Code (UPIC) available? (A 15 digit alphanumeric code issued by
MCD)

Yes No

FOR COMMUNICATION
 Property No. Khasra No. Block No. Floor

Flat 4032 Khasra Number... 4 3rd

Premise Portion Sector/Phase/Mohalla/Building Name/Other details Street

-Select- POCKET 9B, DDA FLATS Street...

Area * Landmark Landmark Details City Postal Code

JASOLA, SOUTH -Select- Landmark Details... 110025

WHERE SUPPLY IS REQUIRED

Nearby Locality Division

POCKET 9A JASOLA VIHAR NEW FRIENDS COLONY

Is supply address same as communication address?

Property No. * Khasra No. Block No. Floor

Flat 4032 Khasra Number... 4 3rd

Premise Portion Sector/Phase/Mohalla/Building Name/Other details Street

-Select- POCKET 9B, DDA FLATS Street..

Area Landmark Landmark Details City Postal Code *

JASOLA, SOUTH -Select- Landmark Details... 110025

Do you have Open RoofTop

Area?

Yes No

Nearest House No./CA No.

Connection Details

Permanent Temporary

Temporary connection exists at Yes No

site?

Purpose of Supply * Category of electricity usage *

NEW CONNCECTION Domestic

Load (KW) Meter Type

Single Phase
5
Three Phase

Type of Area Type of Premises Type of Use/Building

 DDA Owned Residential Building

Important Documents

Important Note :

For ownership proof - Sale Deed/Conveyance Deed/Allotment Letter/Valid Lease agreement/Mutation certificate issued by Govt
authority/sub division agreement/GPA.
Ensure all pages (front and back side) of the relevant document are uploaded.
All uploaded documents should be self-attested by applicants(s) on photocopy of original documents.
All uploaded documents should be clear & readable.
Uploaded documents should be in Pdf format . Ownership proof document within size limit of 25 MB & other documents within size limit
of 5 MB .

 Identification Proof (Self Attested) (Anyone in PDF Format)*

ID Proof Type. * ID Proof Doc No. *

Aadhaar-1.pdf
Aadhaar Card 525951832898

 Ownership Proof (Self Attested) (Anyone in PDF Format)*

Allotment Letter/Possesion Letter Possession Letter.pdf

Compliances CheckList

 ELCB/RCCB (Earth Leakage Circuit Breaker/ Residual Current

Circuit Breaker) installed
ELCB should be installed at premises where applied load is 2 KW and
above.

 Internal Wiring at the premises has been tested by a Licensed

Electrical Contractor/designated officer of the Government and the
test Certificate is available with the applicant.

 Do you have Stilt Parking? Yes No

 Is your building height under 17.5 meters? Yes No

 Do you have lift installed? Yes No

 Lift is installed in premises and the applicant has obtained the Lift
Fitness Certificate from the Electrical Inspector for the lift in the said Yes No
premises and the same is available with the applicant.

 Do you want to avail e-Bill Services(paperless) on email? Yes No

 Do you want to opt out for voluntary subsidy benefits - Yes/No? Yes No

 Do you want to purchase your own CEA approved meter having

Yes No
additional features as per discom make & specification of Meters

SELF - DECLARATION FORM / UNDERTAKING

I, MOHD SALAMUDDIN Son/Daughter/Wife of MOHD SAMDANI Resident of Flat No. - 4032,Block No. - 4,Floor 3,POCKET 9B, DDA
FLATS,JASOLA, SOUTH, New Delhi, 110025 (hereinafter referred to as "Applicant", which term shall mean and include executors,
administrators, heirs, successors and assigns), do hereby swear and declare as under:

Or
The , a company incorporated under the provisions of the Companies Act, 1956 or as amended, having its registered office at ____ (hereinafter
referred to as "Applicant", which expression shall, unless repugnant to the context or meaning thereof, include its successors and assigns),
through its duly Authorized representative Mr. ____ do hereby swear and declare as under:

Or
A Sole proprietorship/ a partnership firm having its office at ____ (hereinafter referred to as the applicant which unless the context otherwise
provides includes its successors and assigns), through Mr. ____ , who is a partner or a duly authorized representative do hereby swear and
declare as under:

THAT the Applicant is a lawful occupant of the premises at Flat No. - 4032,Block No. - 4,Floor 3,POCKET 9B, DDA FLATS,JASOLA, SOUTH,
New Delhi, 110025(hereinafter the "Premises").

THAT the Applicant has requested the licensee to provide a service connection at the above-mentioned premises in the Applicants name for
the purpose mentioned in the application form.

THAT in furnishing the present Declaration, the Applicant has clearly understood that should any of the statements in this declaration prove to
be false or incorrect at any later stage, the licensee shall be within his lawful rights to disconnect supply to the premises without any prior
notice and proceed to adjust electricity supply dues payable by the applicant against consumer security deposit and /or recover the same in
accordance with Law.

THAT the Applicant has complied with all requirements under all statute for the time being in force and the Applicant himself/herself shall be
held legally responsible for any issue arising out of any such noncompliance for which the licensee may initiate action in accordance with
applicable law.

That I, the Applicant hereby agree and undertake:

1. That no objection certificate for seeking electricity connection from the co-owner has been obtained (in case the applicant is not the
sole owner of the premises).

2. To indemnify the licensee against all proceedings, claims, demands, costs, damages, expenses that the licensee may incur by reason
of a fresh service connection given to the Applicant.

3. That to the best of applicants knowledge, all electrical works done within the premises are as per Central Electricity Authority
(Measures relating to Safety and Electricity Supply) Regulations, 2023 as amended from time to time.

4. That the internal Wiring at the premises has been tested by a Licensed Electrical Contractor and the test certificate is available with the
applicant :

Provided that in case of Government quarters/ offices, the certificate issued by the designated officer of the Government may be
accepted by the distribution licensee.

5. That the building has been constructed as per prevalent building Bye-Laws and the fire clearance certificate, if required, is available
with the Applicant.

6. *That there is a provision of lift in premises and the applicant has obtained the lift fitness certificate from the Electrical Inspector for
the lift in the said premises and the same is available with the applicant. (*If applicable)

7. That the applicant has applied for the correct category of tariff as per the applicable tariff schedule. For either of the following
categories of connection, the applicant has the relevant documents available with him.

A. Industrial (whichever is available)

a. (i) Valid Industrial License, or

(ii) Factory License, or

(iii) Household licence, or

(iv) Lal Dora Certificate in case of rural village, or

(v) Any other document authorizing the applicant to run the industry

OR

b. (i) Occupancy-cum-completion certificate from concerned Municipal Corporation or DDA, or

(ii) Consent to Establish from Delhi Pollution Control Committee(DPCC),or

 (iii) Provisional Industrial License, or

(iv) Sanctioned building plan from concerned Municipal Corporation or DDA

B. Agricultural Consumers

i. Certificate of Residence from Block Development Officer,

C. Non-domestic for Khokhas and Temporary Structure

(i) The Bazaari Receipt Number, or

(ii) No Objection Certificate for Khokha/Temporary Structure from concerned Municipal Corporation of Delhi or Delhi Development
Authority or any other concerned Land Owning Agency. Please provide following information in respect of certificate available with
the applicant. (Certificate No., issuing authority, date of issue, Purpose, validity, if applicable)

D. Charging station for electric vehicles - An undertaking by the applicant that the charging station for electric vehicles is as per the
Specifications as may be specified by Central Electricity Authority or Bureau of Indian Standards from time to time.

8. *That the industrial connection is taken based on the documents mentioned in clause 7A(b) above and I shall obtain the valid
document as mentioned in clause 7A(a) above within a period of 3 months from issue of electricity connection. (*If applicable)

9. That above referred applicable documents/certificates indicated at various points are available with me and can be inspected by the
Licensee at any time. In case of failure or reluctance to produce/allow the inspection of said documents/certificates the licensee may
disconnect the connection granted owing to such failure/, reluctance.

10. That I shall provide a legible and certified copy of any of above applicable documents to the licensee pursuant to order/request of
any government agency, judicial forum or any other authority seeking such information.

11. That my industry/trade has not been declared to be releasing obnoxious hazardous/pollutant by any government agency and that no
orders of any Court or judicial authority would be breached by running of my industry/trade or granting any electricity connection to the
same. The licensee is indemnified against any loss accrued by the applicant on this account that on an Order issued by a Court of law or
judicial authority or any government agency for disconnection of electricity, the licensee may disconnect the supply.

12. That I shall indemnify and hold harmless, the licensee, in case of any injury or incident on account of any fault in electrical work in the
premises, and the licensee shall not be liable for any mishap or incident occurring at the premises to the applicant on account of any
faulty/defective/inferior quality wiring at the premises for which the connection is being applied.

13. To pay the electricity consumption bills and all other charges at the rates set out in the licensee's Tariff Schedule and miscellaneous
charges for supply as may be in force from time to time, regularly as and when the same becomes due for payment.

14. To deposit the additional security deposit and additional service line cum development (SLD) charges, if any from time to time based
on the prevailing Orders/rules, directions and Regulations of the Commission.

15. To abide by the provisions of the Electricity Act, 2003, all applicable laws, conditions of Supply/Tariff Orders and any other Rules or
Regulations as may be notified by the Commission, as applicable from time to time.

16. That licensee shall be at liberty to adjust the electricity consumption charges due/outstanding along with any other charges against
the Consumer Security Deposit paid by the Applicant, in the event of termination of the agreement prior to expiry of the contracted period
or in case of any contractual default as per provisions of regulations/rules/orders/directions of the Commission.

17. That as per Delhi Electricity Regulatory Commission (Supply Code and Performance Standards) Regulations, 2017 or as amended
from time to time, I shall provide suitable and adequate land space for installation of the meter/electrical equipments where the licensee
may have ready access to the same.

18. To allow clear and un-encumbered access to the meters for the purpose of meter reading and its checking etc.

19. That the licensee may disconnect the electric supply under reference, in the event of any default, non-compliance of statutory
provisions and in the event of a legally binding directive by Statutory Authority (ies) to effect such an order. This shall be without
prejudice to any other rights of the licensee including that of getting its payment as on the date of disconnection.

20. All the above declaration given by the Applicant shall be construed to an Agreement between the licensee and the Applicant.

21. That the applicant is having the approval for safety and/or fire clearance for EV charging station wherever applicable from the
concerned department such as Petroleum and Explosives Safety Organization (PESO), Fire Department etc.

22. That I/the applicant do hereby confirm and undertake that in case of falling within the requirement as stated below:

(i) Total cumulative demand of all floors in the plot/ building for LT service connection exceeds 100 kW/ 108 kVA, or

(ii) total cumulative built up area of the premises in the plot/building exceeds 2000 sqm, or

(iii) plot of size above 600 sqm or above,

 I/the applicant shall unconditionally and unequivocally provide the space along with right to access, without any charge & in
perpetuity, for installation of Distribution Transformer to BRPL to energize my connection along with supply to other outside
consumers and shall execute all other documents including Sub-station Space Agreement/ Affidavit as notified by BRPL time to
time.

23. If Unique Property Identification Code (UPIC) is not submitted, I declare that I will submit it with BRPL, whenever it is issued to me by
the concerned authorities.

24. Notwithstanding anything stated herein above, it is agreed by the applicant that it shall keep BRPL indemnified from all third party
claims, compensation, penalty dispute, liability, relating to issuance of electricity connection for EVCS and any other issue related to
operation and maintenance of such EVCS at the site which includes litigation expense also.

UNDERTAKING WITH APPLICATION OF NEW CONNECTION

BSES welcomes its esteemed consumers in its family. Our vision is to be the most admired trusted and integrated utility in the world. We are
committed to provide quality, safe and reliable services to our consumers and committed for consumer satisfaction & operational excellence.
For complying DERC norms, we therefore request you to go through the undertaking and please submit the signed copy along with other
necessary documents at the time of application of connection.

I, MOHD SALAMUDDIN son/daughter/Authorized representative of MOHD SAMDANI resident of Flat No. - 4032,Block No. - 4,Floor 3,POCKET
9B, DDA FLATS,JASOLA, SOUTH, New Delhi, 110025 Connection applied address Flat No. - 4032,Block No. - 4,Floor 3,POCKET 9B, DDA
FLATS,JASOLA, SOUTH, New Delhi, 110025 hereby undertake that I shall:-

1. Provide suitable and adequate space at immediate entry or outside the premises when permanent connection is applied in such a manner
that meter is always accessible to meter reader as notified in DERC Supply Code and Performance Standards Regulations 2017 Chapter-V
Article-29(3). I shall provide minimum space required for meter installation as per the dimensions of meters boxes and bus bar given in below
table:-

Meter & Bus bar Length(mm) Width(mm)

1 phase meter with box 250 150
3 phase meters with box 420 350
1 Ph 2-way Bus bar 250 220
1 Ph 4-way Bus bar 320 300
3 Ph 2-way Bus bar 350 500
3 Ph 4-way Bus bar 350 500
3 Ph 8-way Bus bar 300 500

2. Provide fire clearance certificate when permanent connection is applied in

A. Residential Building:For the dwelling units which are above the heights of 15 meters without stilt parking and which are above the height of
17.5 meters with stilt parking of the building.

B. Other than Residential Building as per applicable building byelaws:

3. Provide seperate meter room at safe and accessible location or lockable and weather proof, fireproof/metal made compartment according
to requisite dimensions mentioned in the table given below for meter installation in the panel as per Regulation 29(2) of DERC (Supply Code
and Performance Standards) Regulations,2017:

Meter & Bus bar Panel Length(mm) Width(mm) Depth(mm)

1 Phase Meter Panel(Each) 425 400 175
3 Phase Meter Panel(Each) 500 500 260
1 Phase Bus bar Panel 425 525 175
3 Phase Bus bar Panel 625 475 260
MCCB/ELCB Box 300 250 260

4. Provide space for meter installation only on the ground floor of my premise having proper ventilation. I shall ensure that no parking of
bike/car provided near meter installation space and the space must have adequate illumination not blocking and entry/exit as per Regulation
29(4) of DERC (Supply Code and Performance Standards) Regulations, 2017 and DDA unified building Bye-Laws for Delhi 2016 dated
24.02.2021.

5. I will provide fire retardant closed panel to install meter box, circuit breaker, main switch, switch gear, electrical vehicle charging point and
associated equipment and same will not install under or near the staircase of my premise as per the notification of DDA unified building Bye-
Law for Delhi 2016 dated 24.02.2021 and letter no. CEI/1/9/2020/263-294 dated 03.05.2021 specially in multi storied buildings.

6. I agree to provide space for meter installation in a premise at one location so that all meters can be installed at one place and energized
from same feeding point to avoid safety hazards.
7. I will provide space for meter installation at two different location (on opposite wall) if electricity of my premise/Entire building is supplied
through two different feeding points on in areas having High Voltage distribution Supply system.

8. It is my responsibly to install fire extinguisher near the meter installation location in case of multiple meters are installed at one location and
I shall be responsible for keeping the fire extinguisher in working condition and be responsible for its yearly maintenance.

9. I will lay underground HDPE pipe & make trench for laying cable inside the premise up to the position of meter installation condidering future
load growth in case of underground service cable, as per the table given below.

HDPE Pipe Sizes for laying of Underground Cables*

Load Cable Size(Sq.mm) Proposed pipe size Dia (mm)
Up to 5 KW 2*10 30
6-10 KW 2*25 36
11-20 KW 4*25 40
21-50 KW 4*50 45
51-99 KW 4*150 65
100-140 KW 4*300 90

10. It is my responsibility to ensure that electrical installation and other related work in my premise to be maintained in such a manner as to
prevent danger due to shock, fire hazards and installation is carried out in accordance with the relevant code and practice.

11. It is my responsibility that no other service pipes and cables shall be taken along the ducts provided for laying power cables and all ducts
provided for power cables and other services shall be provided with fire barrier at each floor crossing in multistoried buildings to adhere the
safety guideline issued vide letter no. CEI/1/9/2020/263-294 dated 03.05.2021.

12. I shall provide space for fixing MS angle (L or I shape of suitable strength)/Anchor hook bolt 10/12 mm to fix on wall of premise, above 15
feet height from road level to support overhead cables.

13. I do hereby undertake and abide to maintain safe distance between my premise and BSES network always as per the below prescribed
norms.

Sr.No Lines/Installation Min. Vertical Clearance Min Horizontal Clearance

(i.e., adjacent to a
Where line is passing (i.e., above a building/structure/balcony etc)
building/structure/balcony etc)
1 Line of voltage up to 650 volts 2.5 meter from the highest Point 1.2 meter from the nearest Point
High Voltage line exceeding 650 volts up
2 3.7 meter from the highest Point 1.2 meter from the nearest Point
to and including 11000 volts
High Voltage line above 11000 volts and
3 3.7 meter from the highest Point 2 meters from the nearest Point
up to and including 33000 volts
Extra High Voltage (EHV) Line exceeding 3.7 meter (plus 0.30 meter for every additional 2 meters (plus 0.30 meter for every
4
33 KV 33000 volts or parts thereof) additional 33kv or part thereof)

14. I shall install ELCB/RCCB at site of load above 1 KW. In order to proper fixation. I shall fix the ELCB/RCCB on the DIN rail channel as per
Regulation 7(5) of DERC (Supply Code and Performance Standards) Regulations, 2017 and the subsequent amendments thereto

15. I shall install protective equipment ELCB/RCCB as well as MCB/MCCB according to the rating required for sanctioned load.

16. I shall complete internal wiring of premise as per Regulation 7 (3),(4) and (5) of DERC (Supply Code and Performance Standards)
Regulations, 2017. I do hereby agree and undertake that I shall ensure that wiring shall be done as per the BIS standards (IS 732) as well as
verified by GoNCTD certified contractors. ELCB/RCCB will be installed preferably near meter and in case lack of space ELCB/RCCB can be
installed near distribution box.

17. I undertake to provide the space outside the house/outside staircase area/common entrance/ corridor/ common parking area/ fire escape
area in building to avoid accidents & I shall ensure to keep escape route safe and free all the time so that the same can be used in case of
calamity. I understand that the compliance of the terms of this undertaking and the other terms as agreed by me in the undertaking documents
is a pre-requisite for the release of electricity connection to me and in case of mine non-compliance of the terms of this undertaking and/or
failure to provide adequate space, BRPL shall be well within its rights to refuse the release of electricity connections, at any stage, without any
liability for any claim from any party whatsoever.

18. I shall provide adequate arrangements to make separate earthing provision before installation of any type of three phase energy meter in
compliance of the provisions of DERC(Supply Code and Performance Standards) Regulations, 2017 and the subsequent amendments thereto.

Undertaking Format for release of connection or re connection based on DERC 6th Amendment Order for Building Height

SELF - DECLARATION / UNDERTAKING

 I, MOHD SALAMUDDIN Son/Daughter/Wife of MOHD SAMDANI Resident of Flat No. - 4032,Block No. - 4,Floor 3,POCKET 9B, DDA
FLATS,JASOLA, SOUTH, New Delhi, 110025 (hereinafter referred to as "Applicant", which term shall mean and include executors,
administrators, heirs, successors and assigns), do hereby swear and declare as under:

A. That the Applicant / deponent is owner / occupant of the premises bearing no. , situated at <Flat No. - 4032,Block No. - 4,Floor 3,POCKET
9B, DDA FLATS,JASOLA, SOUTH, New Delhi, 110025

B. That I have applied for Domestic- new connection (Domestic/ Non-domestic/ Industrial at the above-mentioned address

C. That I have submitted the ownership / occupancy documents of the said premises / property / flat.

D. I understand that mere release of electrify connection / installation of meter/issuance of bill for the use of electricity shall not be termed as
confirming any ownership or other rights over the concerned land or premise.

E. The deponent undertakes:-

(a) The dwelling unit where electricity connection is applied is within the height of 15 meters without stilt parking/ 17.5 meters with stilt parking of
the building.

(b) The electricity connection granted to the premises will not be used for extending electricity supply to other dwelling units.

(c) In case, it comes to my knowledge that there is illegal extension of supply or electricity is used at dwelling units beyond the height of 15 meters
without stilt parking/ 17.5 meters with stilt parking of the building, I will promptly bring the same to the DISCOM's notice.

(d) I do hereby confirm and agree that I shall ensure that NO illegal extension of supply or electricity is used at dwelling units beyond the height of
15 meters without stilt parking / 17.5 meters with stilt parking of the building from my connection. I do hereby undertake that in case the illegal
extension of supply or electricity is used from my connection at dwelling units beyond the height of 15 meters without stilt parking / 17.5 meters
with stilt parking of the building, I shall be liable to pay all outstanding bill of the said unit along with the bill as assessed by BSES without disputing
the assessment and / or raising any claim whatsoever and the DISCOM shall be free to disconnect the electricity connection immediately, without
any notice.

F. I hereby undertake that I shall be using electricity for purposes applied for & shall not use / permit to use in any other manner.

G. I agree and confirm that in case of any declaration containing in the instant undertaking is found false at any later occasion, the same shall
be mutatis mutandis be termed as breach of the

agreement between BRPL and the deponent, and BRPL shall be free to take all such action as permitted under law including the same related
to breach of terms of agreement.

H. I declare that the above statements are true and correct, and I shall be unequivocally liable to abide the terms stated in this undertaking cum
affidavit.

Verified at New Delhi that the content of the above self-declaration are true and correct to the best of my knowledge of behalf.

Note: Please read and accept self declaration/undertaking and scroll down to last to activate check box

Signature

Signature of Applicant/Authorized Signatory or Thumb Impression