BSES BSES ran PowerLite a = a i a Non] Shop EJ Bank CT Hospital CT Raatoriam Fatal — CJ Others 53] |“ Photoarapn ot Bameste ‘han pale [MeO CT Pw ORCS CPW OT Oey igh inaustiat TT arcu Ta Raiway Tato Sune Tange Name Tabara Comecion [=] 1] Rapleants Name tn Capra OWNER OTHER Za] Adress at which Supply is required (Biling Adiress) "Colones PW. Tetaphone We Crt I ee Emal — — Z| Otte aaarans TER Ze | Permanent asdress Te 3] Newent canara Plot Ne. Feeder pilar No (Nearest H. No & New K No. (i-avaabi FT Applied toad tn kn 3] (a Exsing Consumer Ws {Please hl ae apphing change of name, Toad ennancoment redueion, change o Gategory of use etc). {@) Exating Load as per elecraty Bl frye Y = Proot of TNoaraed copy Encoaloniy SRegivered GPa Grificate Ownership/Residence | aryerectme Sage S ‘eteeing Ratonces residence San peed 8 issued by Possess onteters © the Gram lea 8 Pradhan ase cet ‘Councilor cocuente MLAMP of Documer theareain (Please tick) fal areas as noted bythe ‘Appropriate Government. Fire Clearange Cerificate PEReE MER aoetar® | Date ofissue Bits vay ‘oinere TCS HSE Sora Sr | Ry Gr CIS ie 5 | Sm 7 [asaaion Tes Roper Signature of Applicant "ACKNOWLEDGEMENT OF REQUISITION FOR SUPPLY OF ENERGY ‘eplcaon are Date Consumer Name ‘Supp Te Signature of Auhotised Offeer egiatered fie 8525 Aaehan Power Lined -BSES Shewsn, Nob Pace, New Dett"0018,BSES B55 Rar Porn Annexure Il DECLARATION/UNDERTAKING This Declaration/Undertaking is executed on this_ day of 2008 at New Delhi by Mr/Mrs./Ms. aged. ‘son/daughter wife of hereinafter referred to as the Applicant(s) which unless the context otherwise provides includes his/her/iheir respective heirs, legal representalives, successors and assigns and the Applicant(s)hereby swear(s) and declare(s) as under oR .@ company duly incorporated under the provisions of the Companies Act 1956 and having its registered office at_ _____(hereinatter referred to as The Applicant which unless the context otherwise, provides include thelr legal representatives, and assigns, through its authorized representative hereby swears and declares as under oR A Sole proprietorship/a Partnership Firm having its office at (hereinafter referred as the Applicant), which unless the context otherwise provide includes its successors and assigns, through Mr. who is a partner or an authorized representative hereby swears and declares as under. 1, That the applicant(s)is/are lawful occupant(s)/owner(s) of the premises situated at ( _ ) {hereinafter referred as ‘the Premises) the Applicant(s) has enclosed documents in support of his/her proof of residence/ownership. 2 That the Applicant has requested BSES Yamuna Power Ltd./ BSES Rajdhani Power Ltd (hereinafter referred to as The Licensee) to provide a service connection at the above- mentioned premises in the Applicant's name for the purpose mentioned in the application form and the Applicant agrees to take supply of electricity for the afore -mentioned purpose only. 3. That the Applicant undertakes to pay all charges/costs for providing electrical connection at the premises and further undertakes to pay all energy charges and other charges from the date of energisation of the connection at the premises at the rates set out in the tariff schedules, schedule of miscellaneous charges as may be determined by Delhi Electricity Regulatory Commission(DERC) and applicable from time to time. 4, That the Applicant undertakes to clear all accumulated/outstanding dues against the premises and the Licensee is authorized to recover the same from the Applicant or transfer the dues to any existing electricity connection sanctioned in favour of the Applicant. 5. That The Licensee is authorized in the event of defaultif any, by the applicant to disconnect the supply of electricity by issuing a disconnection notice in writing to the applicant in accordance with The Electricity Act,2003 and DERC Regulations as applicable from time to time. 6 That the Applicant shall pay full amount mentioned in the Electricity bill as raised by The Licensee from time to time on or before the last date mentioned in such Bill(s) 7. That all or any taxes/duties, as may be levied by the Central/State Government! Local bodies on the sale of electricity shall be paid and borne by the Applicant. 8, That the Applicant agrees that The Licensee would accept an application from the Applicant for reduction in load only after two years from the date of sanctioning/load enhancement or reduction, whichever is later. All applications for load enhancement by the Applicant would be dealt by licensee as applications for new connection and the Licensee would follow the same procedure as laid down in the case of a new connection, The Applicant also undertakes to pay an advance consumption deposit at the prevailing rates in case of any load enhancement. ‘egitered ofc: BSES Rayhan Power Lined -BSES Shewan, Neb Place, New Dehi10019BSES BSES jan Power ine 9, That the Applicant undertakes to indemnity the Licensee against any loss accrue to the Licensee if the declarations/undertakings of the applicant prove to be false/incorrect or are unfulfilled. The Applicant further undertakes to indemnity the Licensee for any harnvioss to the Licensee's property or for any loss/harm to any third party on account of any fault in the electric work at the premises of the Applicant. 10. That the Applicant undertakes to indemnify the Licensee against all proceedings, claims, demands, costs, damages, and expenses that the Licensee may incur due to providing the electricity connection at the premises of the Applicant. 11. That the Applicant would be bound by the provisions of Electricity Act,2003, all applicable laws, conditions of ‘Supply/ Tariff orders and any other Rules or Regulations as maybe notified by the DERC, which become applicable from time to time, 12. That Applicant undertakes that he would take due care of all the metering devices & equipments and other apparatus installed at the premises by The Licensee and also shall indemnify The Licensee for any loss or damage to such metering devices, equipments & other apparatus. 13, That the Applicant shall provide at his cost, adequate space for the installation of metering devices, equipment and other apparatus to facilitate supply of electricity to the premises. 14, That The Licensee shall have the right to supply electricity to other consumers from the service line or apparatus installed on the Applicant's premises. 15, That the Applicant declares that he shall use electricity only for the purposes for which it has been sanctioned by The Licensee and shall in no way be misused for any other purpose(s). 16. That the Applicant undertakes /declares that he shall not extend/sublet this electricity supply to any other premises without prior written consent of The Licensee. 17. That the Applicant's industry/trade has not been declared to be obnoxious, hazardous/pollutant by any Government agency and that no court orders are being infringed by grant of applied electricity connection at the Applicant's promises. In case ata later date itis found otherwise, then electricity supply would immediately be disconnected by The Licensee without any reference/notice to the Applicant. 18. That grant of the applied electricity connection will not confer any legal right for regularization of bullding/land se in respect to the electricity connection provided at the Applicant's premises. Further, it shall also not confer any tight in favour of Applicant to have permanent electricity connection. 19, That the Licensee shall be at liberty to adjust any dues including electricity consumption charges against the security(advance consumption) deposit or any other deposit paid by the Applicant, in the event of termination of the agreement prior to the expiry of the contracted period or in case of any contractual default 20, That the Licensee shall be at liberty to transfer the dues remaining unpaid by the Applicant, after adjusting the advance consumption deposit, to other service connection(s) that may stand in the Applicant's name at any other location falling within the service area of the Licensee epietered office: 8525 Aaehan Powe’ Lied BSES Shewan, Nobu Pace, New Dett"0018,BSES BSES jan Powe ino 21, That the Applicant would allow clear and unencumbered access to all authorised officials of The Licensee to the premises of the Applicant for the purposes of meter reading, maintenance, Inspection, checking, testing, ate, 22. That The Licensee shall be entitled to disconnect the electricity of the Applicant premises in the event of any default and/or non-compliance of statutory requirements andlor in consequence of an order by statutory authority/ Court of Law, 23, That the Applicant shall deposit Service Connection charges, developmental charges and security (advance consumption) deposit as applicable, as per prevailing DERC tariff notification from time to time within 14 days: of the receipt of notice of this effect trom The Licensee. In case Applicant fails to deposit the said amount within the aforesaid period of 14 days of the receipt of the notice my/our application may be treated as cancelled without any recourse. 24, That in case of road cutting permission that has to be obtained by the prospective consumer from the appropriate authority and itis to be handed over to Asstt. Engineer ).The road cutting charges are to be borne by the consumer. 25. That all details furnished in this Application Form are true to the Applicant's knowledge. If any information is found incorrect at a later date, then The Licensee will have the right to withhold/disconnect power supply to the Applicant's promises, ‘A. The Licensee is prepared to accept the declaration and agrees to supply electricity subject to completion of all the formalities and deposit of requisite amount towards the security by the Applicant(s) B. The Applicant hereby declare that liwe desire to have and agree with the Licensee to take a supply of energy, if given, for the above mentioned purposes for a period of not less than two years from the date of commencement of the supply and to be bound by the provisions of the Electricity Act, 2003, conditions of Supply Tariff order and other applicable Rules/Regulations. In the event of this connection being given, this application along with the declaration shall be treated as an agreement forthe connection with effect from the date the connection is given tl such time as itis replaced by a fresh agreement or this agreement is terminated. Signed and delivered in the presence of: Witnesses 1 Signature of the Consumer 2 Signature of the BM(D) epietered office: 825 Aaehan Powe’ Lied BSES Bhawan, Nebr Pace, New Dett"0018,