NEW SERVICE APPLICATION FORM

Customer Care Office

Plot No. ESS, Tugalpur, Plot No. ESS, 33/11 kV, Affix Applicant's Latest
Sector TechZone-IV,
Sector Knowledge Park-I,
Greater Noida, Greater Noida (West), For Domestic Supply Only Passport size Colour
U.P. 201310 U.P. 201009 USE ONLY CAPITAL LETTERS Photograph
(Mon.- Fri. 10:00 am to 05:00 pm)

GSTIN:09AAACN4984D1ZC | CIN: U31200UP1992PLC014506

Date D D M M Y Y Form No. NSC/2023-24/____________

Section 1. Applicant's Details

1a. Application Mode Camp CR Helpdesk
1b. Title Mr. Mrs. Ms. Others (Please specify) _________________________________________________________________
Name of Applicant (as mentioned in the proof of identity applicable for individual)
F I R S T L A S T
Occupation: Salaried Business Self-Employed Others (Please specify) ____________________________________

Aadhaar UID PAN No.

Father/Husband's Mr. F I R S T L A S T
Name:
1c. In case of Joint Application, Please enter the name of Second Applicant below:
Title Mr. Mrs. Ms. Others (Please specify) __________________________ Relation: W/o H/o D/o S/o

Name: F I R S T L A S T

Section 2. Address where Supply is required

2a. House No. Floor Block

Building Name

Street

Sector / Village PIN Code

City GREATER NOIDA Near by Landmark

BP No. of nearest Consumer 2 0 0 Pole No:

2b. Type of Premises: Owned Rented/ Lease Jhuggi/ Jhopri Plot/ Flat Size sq.m. Covered Area sq.m.

If Rented, Please provide details (Period of Registered Rent Agreement) Valid From D D M M Y Y Valid To D D M M Y Y
If Rented, Please provide Land Owner's Details:
2c. Land Owner's Details: Name & Address
If Rented, Please provide Land Owner's Details:
Mobile No.

Section 3. Correspondence Address Please tick if same as above

3a. House No. Floor Block

Building Name

Street

Sector / Village PIN Code

City State

Landmark

3b. Mobile No. Alternate No.

3c. E-mail Id

Section 4. Other Details

4a. Total Contract Demand: Kw Phase: Single Phase (220/230 Volts) Three phase (440/400 Volts)

4b. New Service: Permanent Connection Temporary Connection (for Construction purpose) Temporary Connection (Jhuggi/Jhopri)

4c. Billing Type: Pre - Paid Meter Post - Paid Meter

Section 5. Details of Previous or Other existing connection at same premises

Whether Electricity connection ever requested for the same premises in past/existing any connection ? No Yes (If Yes, Please provide detail)

(a) Consumer No. 2 0 0 (b) Sanctioned Load Kw (c) Status : LIVE PD TD

(d) Consumer Name.

(e) Payment of Arrear (if any) Rs. (f) Note:

 ENCLOSURES: List of Documents required as applicable (tick if required) M-Mandatory,O-Optional
Document required for Urban Applicant Document required for Rural Applicant
a. Photographs: M a. Photographs: (a) 1-Passport size photograph of Applicant M
1-Passport size photograph of Applicant (b) 1- House Photograph ( For Rural Connection)
M

b. ID Proof: Aadhaar Card & Pan Card M b. ID Proof: Aadhaar Card & Pan Card
(a) For a Female Applicant- Both Husband and Father-in-law ID Proof M
(b) For Male Applicant: Father's ID Proof
c. Address Proof :Aadhaar Card M c. Address Proof :Aadhaar Card M
Voter Card /Driving license/Telephone Bill /Passport/Bank Voter Card /Driving license/Telephone Bill /Passport/Bank Passbook
Passbook/Gas Connection Bill (If Aadhaar Not available) /Gas Connection Bill (If Aadhaar Not available)

d. Ownership Proof: (a) Registered Sale Deed/Lease deed M d. Ownership Proof: (a) Khasara & Khatauni (Agricultural Land) M
by GNIDA /UPSIDC. (Complete Set Photo Copy both side) (b) Sale Deed (in case of Freehold or Agricultural Property) M
(b) NOC on Rs. 10 Non-Judicial Stamp Paper M (Complete Set Photo Copy both side)
Self attested ID Proof of Co-owner (In case of joint property) (c) Undertaking by way of Affidavit on Rs. 10/- Stamp paper (Notarised)* M
e. Building Completion Certificate Issued by GNIDA/UPSIDC M *: If Ownership Proof is not available with Rural Applicant.
f. Rented Property Case : e. Rented Property Case :
(a) Registered Rent Agreement & Owner's registered lease deed And M (a) Registered Rent Agreement & Owner's registered lease deed. M
Owner consent letter on Rs. 10 Non-Judicial Stamp paper. And Owner consent letter on Rs. 10 Non-Judicial Stamp paper.
(b) NOC On Rs. 10 Non-Judicial Stamp Paper {(With Self attested ID M (b) NOC On Rs. 10 Non-Judicial Stamp Paper {With Self attested ID M
Proof of Co-owner (In case of joint property)} Proof of Co-owner (In case of joint property)}.
M M
g. B&L Form for >5Kw: Certified by Licensed Electrical Contractor f. B&L Form for >5Kw: Certified by Licensed Electrical Contractor

Self attestation of document by Applicant is mandatory Self attestation of document by Applicant is mandatory

COMPLIANCES
The following must be complied with prior to making payment towards service charges and other stipulated deposits/charges

a. Civil work to accommodate the Company's service apparatus is ready (meter's back wall to be 10" thick brick construction with plaster.)
b. Mains switch must be installed next to the meter.
c. Earthing connection terminal provided from consumer's end at the meter board position.
d. Way leave permission, if required.
SERVICE LINE PERMISSION - NPCL
With reference to premises no. _____________________________
I/We being owner(s) of the building give my/our unequivocal consent for taking electricity connection to myself/tenant and authorize NPCL to:
Install a Service Line,
i. Cut-out and Meter Board
ii. Alter the existing Service Line, Cut-out and Meter Board
Note:

iii. Use existing spare loop and/or

iv. Undertake any activity to energize the connection
a. It shall not be incumbent on the company to ascertain the validity or adequacy of any way leave or sanction from the consumer.
b. Electric Connection shall not be treated as a proof of ownership of the Premises.
DECLARATION
I/We,............................................................................., solemnly assure and undertake that:
a. I/We hereby desire to have and agree with the Licensee to take a supply of energy for the above mentioned purposes, for a period of not less than 2 years from the date of commencement of
supply and to pay for the energy so supplied and all other charges at the rates set out in Tariff Order as approved by the Uttar Pradesh Electricity Regulatory Commission from time to time.

b. I/We also agree to be bound by all the terms and conditions of the U.P. Electricity Supply Code, 2005 as approved by Uttar Pradesh Electricity Regulatory Commission and the
amendments/revisions thereto and the provisions of the Electricity Act, 2003 together with the Rules framed there under and the provisions of CEA (measures relating to safety and Electrical
Safety Regulations, 2010) as amended from time to time.

c. I/We also declare that in the event of my/our failure to comply with the above provisions, it shall be lawful for the Licensee to discontinue the supply in terms of the U.P. Electricity Supply
Code, 2005.

d. I/We further declare that the Licensee shall not be held responsible for any interruption/diminution/Curtailment/Staggering/Stoppage of supply etc. for reasons beyond its control.

e. I/We understand that this declaration can be cancelled/terminated after two years by giving written notice to the Company (NPCL) as per the procedure described in the U.P. Electricity
Supply Code 2005.
f. I/We further agree that this declaration given by me/us shall be construed as an Agreement with the Licensee to the above effect.
g. I/We undertake to use electricity as per the declared load. I/We shall ensure not to draw excess load and incase, my load exceeds the declared/contracted load, I/We shall immediately apply
for enhancement of load.

h. I/We undertake to utilize the electricity strictly in terms of the application submitted by me/us. Theft / diversion of electricity, by-passing the meter, tampering with electricity meter,
associated equipment and installations is a punishable offense under the provisions of the Electricity Act, 2003.

i. I/we undertake to intimate the Licensee as per the procedure described in the “U.P. Electricity Supply Code - 2005” as amended from time to time whenever I/We intend to vacate the
premises for which the electric connection is being taken.

j. You are required to make payment within 90 days from the date on which this estimate bill has been issued, failing which the estimate shall be
treated as cancelled and accordingly your application is rejected on account of non-payment of estimated bill.
k. I/ We declare that all details furnished in the Requisition form are true to my /our knowledge and nothing has been concealed . If any information is found incorrect at a later date, then the
licensee shall have the right to withhold/disconnect supply as the case may be.
I/We have read and understood the above Terms & Conditions and Declaration and agree to abide by the same.

Date: ____/_____/______ 1st Applicant's Signature 2nd Applicant's Signature

(In case of joint application)

Form Received By: _________________________________ _____________________________________

Name of Licensee's Representative Signature of Licensee's Representative

 PERSONAL BOND (Mandatory Document)

I………………………………..............………..………… son/daughter/wife of Mr. ……………............…...……………………..……….........…… resident

………………………….......................…………place of electric connection ..........................….....…………..........declare that I have applied
for New Connection for residential load to the supplier……..................................……..........……………………..

That details of load in the connection are as following:-

220/230 Volts 440/400 Volts

[Link] Load R Phase Y Phase B Phase Total Load

1 Light Points

2 Fan Points

3 5 Amp Plug Points

4 TV Points

5 Tube Light Points

6 C.F.L/LED's
15 Amp Plug Points
7 (Used for Geyser, Emerson Rod, Home appliance )

8 Motor (Complete Details)

9 Air Conditions

10 Cooler

11 Exhaust Fan
Total

The above work has been done by Government licensed electrical contractor. Every fact mentioned in personal bond is true to
the best of my knowledge & belief, If there is any difference in electric load & load mentioned in personal bond or any fact is
found false/ incorrect, I will be fully responsible for that.

Date: ____/_____/______ _____________________________ ______________________________

1st Applicant's Signature 2nd Applicant's Signature
(In case of joint application)

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ACKNOWLWDGEMENT

Application from Mr./Ms. ______________________________________ for requisition of Temporary/Permanent supply is received. The reference
no. ______________________________________shall be used in all future correspondence.

_______________________________________
Date: ____/_____/______ Signature of Licensee's Representative
 Rejection remarks in case of incomplete application
1 Interaction ID:-…...………………… 3 Interaction ID:-…...…………………
Date:-…………………………………………………. Counter No.:-.……………….. Date:-…………………………………………………. Counter No.:-.………………..
Reason of Non-acceptance:- Reason of Non-acceptance:-
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2 Interaction ID:-…...………………… 4 Interaction ID:-…...…………………

Date:-…………………………………………………. Counter No.:-.……………….. Date:-…………………………………………………. Counter No.:-.………………..
Reason of Non-acceptance:- Reason of Non-acceptance:-
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PAYMENT OPTIONS

FOR NEW SERVICE ELECTRICITY BILLS

NPCL MOBILE APP,
ONLINE BANKING ON NPCL
WEBSITE & MOBILE WALLETS

ELECTRONIC FUND TRANSFER

THROUGH
NEFT / RTGS

DEPOSIT CHEQUE

SWIPE YOUR DEBIT/CREDIT

CARDS AT OUR OFFICE

DEMAND DRAFT OR
BANKER'S CHEQUE

PAY CASH

[Link]:Electric Sub-station, KP-IV, Greater Noida, Gautam Budh Nagar, Uttar Pradesh - 201310
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This is how your --application
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Submit Check for Technical Estimate Service & Meter

Check for Commercial / Service Energization Billing Starts
Application Feasibility through Payment Installation
LCC Dues
GIS
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