Con Code Contract Demand ...................

kVA
For Office
Use Only Purpose Tariff Date of Connection
Affix recent Passport
size Photograph of
Kerala State Electricity Board Limited applicant / authorised
(Registered Office: Vydyuthi Bhavanam, Pattom, Thiruvananthapuram – 695 004
Website: [Link] CIN: U40100KL2011SGC027424)
signatory

Application for Service Connections

for Demand Based Tariff (EHT / HT / LT)

Name of applicant (in Capital Letters)

1 If connection is Name of Organisation
required for an
Organisation Designation of Applicant
If in industrial Name of the authority /
2
area / SEZ etc developer of area / SEZ
Individual / Govt Govt
3 Category Proprietary
Partnership Private Ltd Public Ltd Society
Department undertaking
Address of premises where electricity
Present address (for communication)
connection is required
Name of Building
Building Number
4 Lane / street
Place / Land mark
District / Pin Code
Village/Survey No.
E mail
5 Status of applicant Owner Tenant 6
Whether Power Intensive or not Yes No
Whether properties of others If YES, whether Consents obtained in all
7 Yes No Yes No
need to be crossed over cases
Domestic If non domestic, provide details of activity / Type of Connection (√)
Purpose manufactured product
Commercial Permanent Temporary Seasonal
of Supply
8 Industrial 9 If temporary / seasonal,
Please
Agricultural Period of From
tick (√)
Others requirement To
Connected Load
11 PAN No
(kW)
10
Contract Demand
12 AADHAR No (if available)
(kVA)
13 Area of the premise Constructed area (m2) Plot size (m2)
Whether the unit has been in operation earlier?
14 Yes No
( If YES, details may be provided separately)
If applicant desires a particular Date of Inspection, specify the Date*
Preferences (This may attract additional expenses)
15 of applicant Whether a Dedicated Feeder is required Yes No
(Optional) If Dedicated feeder is availed, whether Protected Load Status is sought Yes No
Whether consumer wishes to purchase meter (as per CEA approved specification) Yes No
I, ………………………………………………………………, son/daughter of ……………………………………………… hereby declare
that I have attained 18 years of age, that the information provided in this application is true to my knowledge, that the internal wiring
of the premise has been tested by ............................................................................................................. (name of licensed wiring contractor)
who is having a valid License No ................................................................................ and the test cum completion certificate / energisation
approval No ............................................................................................................................ for the above mentioned connected load is
available with me. I further confirm that there are no orders of Court / Govt restricting electricity connection in the premises
Date: Signature of the applicant / authorized signatory
Place: Name:
Proof of Identity Letter of Authorisation Details of Property Crossing & Consents
Documents
attached Proof of ownership Consent from Owner Test Certificate of metering equipment
Please tick (√)
Agreement Dimensioned sketch Others Specify
Particulars of Consents / NOCs required / produced

* Proof of ownership to be produced separately

If applicant is tenant /

I /We, …………...………....…………………...........…............….. .........................................being registered title holder(s) and

the absolute owner / joint owner(s) of property comprised in Sy No ............................ of ......................................... Village,
bearing building no. ...........................of .................................................................. (local body) do hereby give my / our consent
occupier *

to Sri / Smt ......……..................…...…………………..........., who is a joint owner / tenant / occupier of the above premise to
wire and avail service connection from KSEB Ltd in his name as consumer at the above premises. I/We shall inform KSEB
as and when the premise is vacated.

Name & dtd signature of Name & dtd signature of Name & dtd signature of
owner/ joint owner(s) first witness second witness
(i) No of properties to be crossed (ii) No of consents obtained
I / We hereby give consent for drawing electric line through my / our property mentioned below for giving
electric connection to Sri / Smt ……………………………..…………………………………………………………
Name & Address of property Signature of Property
Village Sy No
owners Owner
Consents Received
In case of Property Crossing (use separate sheet if required)

Signature Signature
Name (Witness 1) Name (Witness 2)

No Name & address of property owner Village Sy No

Consents Not Received

Dated Signature &

Name of Applicant
Acknowledgement

Ref No: ...............................................

Application of ....................................................................................(name of applicant), complete in

all respects, for a new Service Connection has been received at this office on .............................
(Date).

The above reference number is to be used for all future correspondence.

Signature of representative /Seal of KSEB Ltd

Name and designation