The power of service

Customer No. (For Office Use)

Under Section 43 of Electricity Act 2003 hereinafter called ‘Act’ and MERC (Electricity supply and other Conditions of supply) Regulation 2005, here in after ‘Regulations’.

Note Intending consumers are requested to see that this form is fully, clearly and legally filled and signed with date before sending to the company. Please tick the box, whichever is applicable. (Please provide complete details)

New Connection

Change in Contract Demand

Changeover of Supply

Additional Load

Change of Name

Change of Tariff Category

Reduction of Load

Shifting

To the premises owned/occupied by me/us and situated within the area of specified in theAdani Electricity License, 2011

Occupation/Designation

Address at which supply is required

Flat No./Building Name

Lane/Street

Landmark

Suburb/City

Area of Premise Sq mtr Email

Pin Code

Phone No. Mob No.

Meter No.

Bank Account Number

Bank Name/Branch

Existing/Nearest Consumer Account number

Name of Owner

Flat No./Building Name

Lane/Street

Landmark

Suburb/city Pin Code

Incase of Premises on Rent or Lease not owned by Applicant

Preferred Bill Language is Marathi Hindi Gujarati English

Type of PremisesOwned Rented Lease Others (Specify)

Note: Please do not staple the photograph

Affix passport sizephotograph and sign across

2.2 The connection will be

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Category of Premises

Chawl Hut Bunglows Multi storied Building Others (Specify)

Residential BPL Charitable/Religious Non Commercial/Educational Others (Specify)

Others (Specify)

Others (Specify)

New Service Tapping

Commercial Office Construction/Power

Industrial (Type of Industry)

I/We hereby submit application for

1 Applicant’s Name Mr/Mrs/Miss/M/s (in block letters)

2 The following are my requirements (Please tick appropriate box) (To be filled by LEC)

First Name Middle Name Surname

16.1 APPLICATION FOR SUPPLY / ADDITIONAL LOAD / SHIFTING / EXTENTION OF SERVICE / CHANGE OF NAME / CHANGEOVER OF SUPPLY

NO. OF POINTS

Total No.

WATTAGE OF EACH VOLTAGE TOTAL WATTAGE

Total no. of Points Total Wattage Contract Demand

Rubber Stamp

CA number

kw

(Incase of any other apparatus attacha separate sheet with specific Wattage)

kva

3 The wiring carried out/certified by the following Licensed Electrical Contractor

5 For Changeover of Supply

6 Change of tarrif category From To

5.1 Meter Number

5.2 The meter would be provided by

Existing Distribution Licensee SelfNew Distribution Licensee

Pin Code

4 Applicant’s Present/Correspondence Address

Flat No./Building Name

Lane/Street

Landmark

Suburb/City

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2.3 Details of the Apparatus

a) Bulbs

b) CFLs

c) Tubelights

d) Fans

e) Geysers

f) Ovens/Microwave

g) Air Conditioners

h) Refrigerators

i) Television

j) Plug-5/15/30 Amp

Valid up toLicence No

Name

Address

Telephone number

Email

d d m m y y y y

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Business Partner Number

Contract A/c Number

Applicant’s Signature Date

Indicative list of the document/NOC/Clearance Attached

I have read and agreed to the notice above and make the following declarationa) To abide by the provisions of the Electricity Act 2003 and Maharashtra Regulatory Commission (Electricity Supply Code and other conditions of supply)b) To pay for the supply of electricity based on the prevailing tarrif rates of Adani Electricityc) To pay all the charges which are due, in accordance with the above Regulations and approved schedule of charges of the Companyd) To pay the security deposit as per the provisions of above Act and Regulations

Under Rule 45 of the Indian Electricity Rule 1956, no electrical installation work including additions, alterations, repairs and adjustments to existing installation, except such replacement of lamps, fans, fuses, switches, low voltage domestic appliances and fittings as in no way alters its capacity or character, shall be carried out upon the premises of or on behalf of any consumer or owner, for the purpose of supply to such consumer or owner, except by an electrical contractor licensed in this behalf by the State Government under the direct supervision of a person holding a certificate of competency issued or recognised by the State Government.

Where any electrical installation work of the nature specified above has been carried out otherwise than under the direct supervision of a person holding a certicate issued by the State Government and by the electrical contractor licensed by the State Government in this behalf, the consumer owner or occupier, the contractor(if any) or the person through whom the work is being or was carried out and the person under whose immediate supervision the work is being or was carried out, shall each be punishable with fine which may extend to Rs. 300/- under the Rule 139 of the Indian Electricity Rule 1956.

IMPORTANT NOTICE

Please note that no consumer/applicant who have defaulted in payment of electricity bills and other charges shall be allowed for a change over without clearing dues of the existing distribution licensee.

The consumer/applicant shall submit the proof of its payments of last bill as served by the existing distribution licensee and other relevant documents as required under Electricity Supply Code.

The consumer/applicant shall not be able to change the name, purpose or classification of category for which the electricity has been provided by previous distribution licensee at the time of changeover.

The consumer/applicant shall be under an obligation to provide the complete details of all the payment arrears/court proceeding or any dispute if any.

The premised of the consumer/applicant shall be inspected to confirm the classification, connected load, technical issues if any, etc and if any default is found, the application may be rejected for the same.

Please note that the existing distribution licensee shall have the right to adjust the security deposit of the consumer/applicant towards the last due bill/arrears.

The consumer/applicant shall ensure that if the sanction loads of the consumer/applicant are equal to or higher than 50 KW, the consumer/applicant shall have to enter into a new agreement with the new distribution licensee at the time of making an application.

Please note that if the consumer/applicant has opted for new distribution licensee’s meter or opt outs for his own meter, the same shall be tested by new distribution licensee in its laboratory in the presense of existing distribution licensee before installation of the said meter.

Please note that if after making an application to the new distribution licensee, the meter reading for the final billing shall be taken jointly by the new distribution

licensee and existing distribution licensee for the preparation of last due bill and the same meter reading shall be opening meter reading for new distribution licensee and such meter reading statements shall be signed by all, i.e. existing distribution licensee, new distribution licensee and the consumer/applicant. In case the consumer/applicant is not present for the reading, the readings taken jointly by existing distribution licensee and new distribution licensee shall be final and binding.

The consumer/applicant shall be liable to pay the outstanding bill amount as raised on final meter reading on or before due date.

The existing distribution licensee or wheeling distribution licensee will be entitled to follow the provisions of law for disconnection of supply under Section 56 of the Electricity Act, 2003 in case of any default of payment by consumer/applicant.

Any change-over consumer/applicant who proposed to change the name, purpose, category shall continue to abide by the condition of the changeover even after change of the name/purpose/category.

The new/supply distribution licensee shall be entitled to initiate appropriate procecedings for misuse of supply against the consumer and accordingly advice the wheeling/existing distribution licensee to carry out disconnection as per the provisions of the Electricity Act, 2003.

The existing/wheeling distribution licensee shall have the right to inspect the meter, and cut out seals from time to time and take meter reading for all changeover consumers.

The existing/wheeling disribution licensee will be entitled to do the assessment as provided US/ 126 (6) of the Electricity Act,2003 and shall provide the said information to the new/supply distribution licensee for billing and recovery purpose and for making the payment to existing/wheeling distribution licensee.

TERMS AND CONDITIONS

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Business Partner Number

Contract A/c Number

Applicant’s Signature Date

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