EPDCL
PDCL New Connection Application Form
Service Type:-
Paste here your
Service Type*: Domestic recent passport
Commercial
General Purpose
size photograph
Consumer Details:-
Aaadhar
dhar Card Number: ________________________________
________________________________Consumer Surname *: ____________________
______________________
Consumer Name*: _____________________
_____________________ Consumer Father Name*: ________________________
_________________________
Social Group *: Others S.C S.T If Others: _______________________________________________
Consumer Type*: Individual Otherss Limited Company Private Company Registered Partnership
UN Registered Partnership
Purpose of Supply*: ______________________________________
______________________________________________________________________________
_________________________________________________
Location of Premises where supply is required
required:-
House No*: _____________ Street*:__________
:_________________________________________________________________
______________________________________
Circle*: Eluru Rajahmundry Srikakulam Visakhapatnam Vizianagaram
Division *:__________________________Sub
Sub Division
Division*: _______________________________
___ Pin Code: ______________
Section Name*: ________________________
___ Phase Type*: Phase -1 Phase -3
Dept Type*: Non Government State Government Central Government Location Type*: Urban Rural Location Name*:: _________________
_______
Existing/ Adjacent Service No if any: ______
___________________ Contracted Load*: ______________________________________
________________________________
Address for Communication:-
Door No*: ___________________
_____ Locality/Land Mark: _____
_____________________________________________________
_____________________________
State*: ___________________________ District
District*: ___________________________ Mandal*: ________________
____________________
Village/Ward*: ______________________
_________________________Pin Code: _________________Mobile Number*:: _________________
_
Email ID: ________________________________
___________ Ration Card No: _______________________________________________
Informant Details:-
Informant Name*: ____________________________________________
_________________________________ Informant Relation*: ___________________
________________
Delivery Type*: Manual ID Proof**: Aaadhar card copy Electoral card copy Pan Card copy Ration card copy Driving Licence Copy Passport copy
ID Proof No*: ____________________________ Type of Ownership: Sale deed Allotment Municipal Tax Receipt Possession Letter Owner
Indemnity bond Will Copy Gift deed copy Pattadar Passbook Partition deed Self Indemnity bond
Wiring Certificate Type*: Contractor Wiring Certificate Self Certified Wiring Certificate
Document List: - (NOTE: All Upload Documents are in PDF format only)
1. Application Form*
2. ID Proof *
3. Owner Ship Certificate/Sale Deed/Gift Deed (Selected Proof Document) *
4. Photo*
5. Wiring Certificate*
6. Signature *
Applicant’s Signature