1.TAKE PRINT OUT OF THE GENERATED APPLICATION FORM.

2.SIGN AT THE SPACE PROVIDED FOR APPLICANTS SIGNATURE.

3.ATTACH A LATEST PHOTO & SIGN ACROSS PHOTO.
4.SCAN THE SIGNED FORM AND UPLOAD.

Online Application Form For NAME CHANGE

REQUEST TYPE NAME CHANGE

APPLICATION REQUEST NO 38063

Latest Photo
SERVICE NO 100184012 Please Sign Across
Photo
TYPE OF PREMISE LT:COMMERCIAL

NAME OF REGISTERED CONSUMER GOKULDHAM DEVELOPERS

NAME OF APPLICANT Ms. Tanuja Dhagia

LEGAL STATUS OF APPLICANT OWNER TOTAL LOAD(KW) 6.000

ADDRESS : CORRESPONDENCE ADDRESS :

407 -G 407 -G
TITANIUM CITY CENTER. TITANIUM CITY CENTER.
293/1/P, T,P-03.100FT, ROAD. 293/1/P, T,P-03.100FT, ROAD.
NR SACHIN TOWER, NR SACHIN TOWER,
ANANDNAGAR.AHMEDABAD,15, ANANDNAGAR.AHMEDABAD,15,
380007 380007,

MOBILE NO 8422948727

EMAIL siddharthdhagia@gmail.com

To,
Torrent Power Limited
I/We hereby request for New Connection/ Reconnection/ Load Alteration in Existing Connection to supply electrical energy at Low
Voltage for the premises owned/ occupied by me/ us.

Declaration
I/We hereby declare that [a] The information provided in this application is true to my knowledge [b] I/We desire and agree with the
distribution licensee to avail power supply for the above mentioned purpose and of the load shown in this application form for the
period not less than two years from the rst day of the month next to date of commencement of power supply by the licensee. [c]
I/We have read the Supply Code issued by GERC and agree to abide by the condition mentioned therein. [d] I/We will deposit
electricity dues regularly as per the applicable electricity tari and other charges. [e] I/We will own the responsibility of security and
safety to the meter cut-out and the installation thereafter.

SIGNATURE OF APPLICANT WITH DATE (If signing on behalf of a institution or company please ax the company
stamp)
IMPORTANT POINTS

1) Please ensure all relevant details are lled clearly and are complete is all respects.
2) In case of application of transfer of name, the applicant shall comply with relevant regulations.
3) In case of application for transfer of name the lieu of deceased person is required to submit the death certicate as well as
succession certicate.
4) If the occupier is unable to obtain no objection certicate from the owner of the premises, they may visit company's ocer
personally.

REQUEST YOU TO READ THE DOCUMENT CAREFULLY AND SIGN WHENEVER APPLICABLE.

UNDERTAKING

I/We take the responsibility that the document submitted along with proofs for the name change process is the latest proofs and
there is no change in the ownership of the property after the date mentioned. The documents submitted are authentic and reects
ownership/ legal occupancy of the premise. I/We will be held responsible for any legal objection from past owner or any other
person and it will be my/our part of duty to resolve the objection at my/our cost and risk also and shall indemnify company against
any such losses the company suers and assign the right to revert back the name to previous owner. I assure that there is no legal
order or pending legal cases on the ownership of this premise. I adhere by the companys rules and regulations and abide by the
provisions of Supply code. I /We are liable to pay any type of outstanding dues against the service, any type of dierential security
deposit and any dues left from the previous owner of the service.

NEW CUSTOMERS SIGNATURE____________________

NO OBJECTION CERTIFICATE

I the undersigned declare that according to company records the premise with current service no 100184012 is sold/ rented for
residential/commercial activity in accordance to sale deed, sale documents, live and license agreement and I have no objection to
change the name of the service owner to the applicants name. I also agree to the company rule that any security deposit amount
in the service no account or the paid dierential security deposit will be transferred to new name customers account.

EXISTING (OLD) CUSTOMERS SIGNATURE__________________

 JOINT OWNERSHIP APPROVAL

Respected Sir/Madam

SUBJECT-Name change for Service No 100184012

The above stated electricity connection, having service no 100184012 is attached to jointly owned property of the undersigned
owners. We have no objection if the above mentioned service connection is being transferred to the name of Shri/Smt Tanuja
Dhagia

Joint Owners Name SIGN