Application No.......................

Connection No.......................

Date of receipt……………………

Signature of Authorized Official

HPSEBL Form CS-1 (a)

HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED (A STATE GOVERNMENT UNDERTAKING)

Book No Serial No

APPLICATION

&

AGREEMENT

FOR SUPPLY OF

ELECTRICITY

To

The Assistant Engineer/Assistant Executive Engineer/Executive Engineer,

Electrical Sub- Division, HPSEBL Limited,

________________ District___________ (HP)

I/we hereby agree to take from the Himachal Pradesh State Electricity Board Limited (hereinafter

referred to as the supplier) at the premises stated below, a supply of electrical energy not exceeding the connected load & contract demand of my/our installation as noted below and I/we

hereby further agree to pay for the said supply in accordance with the relevant tariff and also to

pay for all such other charges as may become due by me/us to the supplier from time to time at rates laid down in the Schedule of Tariff and Schedule of General & Service charges prescribed by

the HPERC and I/we further agree that I/we will, if and when required by the supplier to do so, lodge with the local office of the HPSEBL a deposit calculated as per HPERC (Security Deposit)

Regulations, 2005 & HPERC(Recovery of Expenditure for Supply of Electricity), Regulations 2012,

its amendments from time to time and any other charges which may become due from time to time And I/we hereby declare that the HPERC regulations, conditions of supply, tariff order ,

General & Service charges have been perused by/read to me/us and I/we agree to be bound by them and by the provisions of Electricity Act and of the Rules & regulations made there under, as

may be applicable:

(i) I/we agree to be bound by the provisions of the Electricity Act 2003 (Act No 36 of

2003), Codes and Regulations made by HPERC/CERC/CEA thereunder as are in

force for the time being and may be amended from time to time.

(ii) I/we further require you to supply me/us meter/meters on hire in terms of section

55 of the Electricity Act 2003 and I/we agree to pay monthly meter rentals as may be fixed by the HPERC under “Schedule of General & Service Charges” of the

Tariff Order from time to time.

(iii) I/we agree that in the event of failure on my/ our part to make the payment of HPSEBL dues, for this connection, it would be within the HPSEBL lawful right to

transfer the same to my/our other connections and these connections can/ will be liable for disconnection for continued default, under section 56 of the Electricity

Act 2003 and various other enabling provisions in this regard as per the HPERC Regulations/Codes.

(iv) I/we agree to pay outstanding amounts in my/our house for the use of Electricity

in any other premises which I /we have vacated. Licensee will have the right to not to supply/disconnect my/our connection in such cases as per clause 5.2.13 of

the Supply Code 2009 and its amendments by HPERC from time to time.

Signature of Applicant……………..

Contd.. 2/-

NOTICE

The applicant should hand over this application to the Local Office of the

HPSEBL in the area in which the supply is required along with a non-judicial

stamp paper for Rs. 10.00 duly crossed and signed

[2]

(v) I/we agree that in the event of failure to avail the connection, the Security

Deposit & the amount towards HPERC(Recovery of Expenditure for supply of electricity) Regulations deposited by me/us may be forfeited as per the relevant

provisions of H.P. Electricity Supply Code,2009 & HPERC (Recovery of Expenditure for supply of Electricity) Regulations,2012 and its amendments as may be in force

from time to time.

(vi) I/we hereby agree that I/we shall accept any restrictions imposed by the Licensee in order to comply with the regulations made by the Authority under section 53 of

the Electricity Act 2003 and any terms restricting the liability of the Licensee for economic loss resulting from negligence of the consumer, as per clause 3.7.1 of

the Electricity Supply Code 2009 and its amendments by HPERC from time to

time.

(vii) I/we hereby agree that I/We shall abide by CEA(Measures related to Safety and

electrical Supply) Regulations,2010 & its amendments, HPSEBL Electrical Safety Manual and General Safety Instructions, Electricity Rules under Electrical Act & its

amendments, CEA( Safety Requirements for Construction, Operation and Maintenance of Electrical Plants and Electrical Lines) Regualtions,2011.

(viii) I/We hereby agree that I/We shall abide by the power cut restrictions/peak load

hours restrictions.

Name of applicant..................................

S/o, D/o, W/o..........................................age...........

PAN No. …………………………………… Adhaar No………………………………..

Mobile No.__________________ Tel. No………………………………………..

Email…………………………………………………………………..

Occupation............................................

Description of premises..................................No. of Rooms................................... House No. ................................................................................................................................................

Road......................................................................................................................................................................................................................................................................................

………………………………………………………………………………………………………………………………………..

The wiring work will be/has been carried out by (Name)............................................................

Full Address of Premises ...........................................................................................................

............................................. ..................................................................................................

................................................................................................................................................

1. Schedule of energy consuming apparatus to be connected:

Description of apparatus

Lamps, Tubes etc. Fans Heaters and Refrigerators etc.

Motors

No.

Wa

tta

ge

Total

kW

No.

Wa

tta

ge

Total kW

No. h. p. each Total KW

1-Ø 3-Ø 1-Ø 3-Ø

1 2 3 4 5 6 7 8 9 10 11 12

Total

[In case of Extension in load, the existing & additional Load is to be indicated separately]

Signature of Applicant……………..

Contd….3/-

Space for Photo of applicant /

Authorised

Signatory)

[3]

2. Total Connected load(kW) of above installation (4+7+11+12).......................... kilowatts

Existing ……………………………(kW) Addl./New……………………(kW).

3. Total Contract Demand(kVA) of above installation (Mandatory for all categories except Domestic Category)............................................... kVA.

Existing CD…………… kVA + Addl. CD …………. kVA

4. Voltage at which supply would be preferred........................kV

5. A) Purpose for which connection is required................................

(Domestic/NDNCS/Commercial/SIP/LIPS/MIP/LIPS/IDWPS/BS/SLS/TMS/RT)

B) Details of other connections existing in the name of the applicant/ sister concerned

i) Account No. ……………………………….ii) K. No………………………………………….

ii) Category……………………………………………………………………………………………

6. PAC details [only applicable in case the contract demand is more than 100 kVA for new/additional load]

Letter No. …………………………………. Dated ………………… Load (kW)…………. CD: ……..(kVA) Valid up to ………………………….

7. Class of Application:

(a) A new connection: ............................................

(i) I am owner/landlord of the premises: ................................................

(ii) An extension to my/our existing installation (connection A/C No. .........................................)

(b) A re-connection (the previous consumers' name is .............................................

and his connection A/c No. is .................................................)

(c) A change of name/title from Shri..................................Connection A/C

No..........................

(d) Change of Supply voltage for existing connection A/C

No……………………………………….

(e) Other(please mention)…………………………………………………………

8. Whether permanent or temporary connection...................................................

9. Approximate date from which connection is required........................................

10. Name of witness............................A/c No..............................Signature........................

Address of Witness .............................................................................................

…………………………………………………………………………………………

11. Declaration by Consumer: As per Format-I enclosed.

Signature of Applicant

Date: ___/____/______/

Place:

__________________________________________________________________________ Note: (i) Application and Agreement Forms will not be signed by a minor.

(ii) Duration of connection & purpose may be mentioned in case of Temporary Meter Supply.

__________________________________________________________________________

NDNS: Non Domestic-Non Commercial; CS: Commercial Supply; SIP: Small Industrial Power Supply ;MIP: Medium Industrial Power Supply ; LIPS: Large Industrial Power Supply ;IDWPS : Irrigation and Drinking Water Pumping Supply ; BS: Bulk Supply ; SLS: Street Lighting Supply; TMS: Temporary Meter Supply; RT: Railway Traction.

Contd……4/-

[4]

(FOR OFFICE USE ONLY)

12. a) Standard Supply Voltage .............................. Volts b) Availed Supply Voltage………….. c) Metering Voltage……………………………………………….

13. Name of Feeding Sub-Station………………………………………..

14. Category applicable as per Tariff Order..............................

15. Details of Amount deposited by the applicant:-

a) Security deposit

Sr. No.

Amount Receipt No. Dated Purpose[New load/addl. CD/Load/revision of security based on average tariff]

i)

ii)

iii)

iv)

v)

b) Normative IDC

Sr. No.

Amount Receipt No. Dated Purpose[New load/addl. CD/Load/revision of security based on average tariff]

i)

ii)

iii)

iv)

v)

c) Cost of Service line/Estimate i) Amount(Rs)…………ii) Receipt No. ……………. Dt…………….

Sr. No.

Amount Receipt No. Dated Purpose[New load/addl. CD/Load/revision of security

based on average tariff]

i)

ii)

iii)

16. Accepted/Sanctioned/ Recommended[ Please Tick ] Signatures……………….

Comments/recommendations Designation AAE/AE/AEE

Dated:……………………….

17. Sanctioned /Recommended[ Please Tick ] Signatures…………………

Comments/recommendations Designation Sr.EE/ASE

Dated:………………………

18. Sanctioned/ recommended [ Please Tick ] Signatures……………….

Comments/recommendations Designation SE/Dy.CE

Dated:…………………….

19. Sanctioned Signatures………………

Feeding arrangement sanctioned Designation CE

Dated:…………………..

FORMAT-I(Page-1)

Declaration/ Undertaking

(to be made as an integral part of A&A form)

I/We______________________S/o, D/o, W/o Sh.___________________aged about _____

Resident of __________________________________________________________/ authorized signatory of ___________________________________ (copy of resolution of BOD in cases of

companies enclosed) hereinafter referred to as the Applicant(s) do hereby solemnly affirm and declare as under:-

1) That I/We am/are the legal owner(s)/occupier of house/plot/premises

No.__________________ situated at ________________________( hereinafter referred

to as ( “The Premises”), in support of which the applicant(s) has enclosed proof of

occupancy/ownership.

2) That I/We have applied to Himachal Pradesh State Electricity Board Ltd. (HPSEB Ltd.)

( “ The Licensee”) for electricity connection at the above mentioned premises for the

purpose mentioned in the Application and Agreement Form and I /We agree to take

supply of electricity for the aforementioned purpose only.

3) That I/We undertake to pay the charges towards Recovery of Expenditure for supply of

Electricity as per HPERC(Recovery of Expenditure for supply of Electricity)

Regulations,2012 and its amendments issued from time to time with the time period as

mentioned in the regulations and further undertakes to pay all energy charges and other

service charges as per tariff order determined by Himachal Pradesh Electricity Regulatory

Commission(HPERC) applicable from time to time. That in case I/we fail to deposit the

charges within stipulated period, HPSEB Ltd. is at liberty not to release the electric

connection/not to allow the extension of load/disconnection of supply to the above

mentioned premises.

4) That monthly average power factor of installation in the above mentioned premises shall

not be less that 0.9, failing which we shall be liable for payment of power factor surcharge

as per tariff order, it shall be obligatory on our part to bring it up by installing shunt

capacitor of requisite capacity and by method approved by HPSEB Ltd. from time to time

with in a period of three months of notice, failing which without prejudice to the right to

collect surcharge, it shall be within lawful rights of HPSEB Ltd. to disconnect our premises

till the improved monthly power factor is brought to 0.9.

5) That I/We undertake that we shall run our factory in ________shifts.

6) That I/we shall strictly abide by the peak load hours restrictions (6.30 PM to 10.00 PM) as

may be enforced by SLDC/HPSEB Ltd. from time to time.

7) That I/we undertake to build up the load to the extent of load sanctioned/sanctioned

Contract demand within period of two months from the date of readiness of HPSEB Ltd.

failing which I/We shall pay charges as per Himachal Pradesh Electricity Supply Code,2009

and its amendments issued from time to time.

8) That I/We undertake 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.

9) That I/We undertake to accept and abide by the provisions of Electricity Act,2003, all

applicable laws, conditions of supply, General Conditions of Tariff and Schedule of Tariff,

Supply Code, rules, regulations, orders, Directives, Notifications issued and enforced under

applicable laws by HPERC/CEA/Govt. of India/Govt. of HP and any other

instructions/circulars issued by HPSEB Ltd. from time to time, and as amended from time

to time, for equitable and efficient distribution of electric energy.

Signature of Applicant

FORMAT-I(Page-2)

10) That I/we undertake HPSEBL to disconnect the supply of electricity without issuing any

notice for disconnection, in case some reference or observation of contravention of any of

the bye laws of any statutory authority/ Central/ State Government Department is

received, by HPSEBL.

11) That I/we shall be solely held responsible for contravention, if any, of Act/ Law of any

statutory authority/ Central/ State Government Department and HPSEBL shall not be

made party on any omission/ contravention by me/ us. Any loss on this account shall be

my/ our liability.

12) That the Licensee is authorized in the event of default, if 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, Code/Rules & Regulations of HPERC

and other statutory authority of State /Central Govt. under State/Centre enactment/

Act/Regulations.

13) That I/We shall provide at my/our cost, adequate space for the installation of metering

devices, equipment and other apparatus to facilitate supply of electricity to the premises.

14) That I/We undertake to indemnify the licensee against any loss accrued to the Licensee if

the declaration/undertaking furnished by me/us prove to be false/incorrect or are

unfulfilled. I/We further undertake to indemnify the licensee of any harm/loss to the

Licensee’s property for any loss/harm to any third party on account of any fault in the

electric work at my /our premises. Further, applicant agrees that if there is any harm/loss

to the property of the Licensee, due to the fault of the electrical network within the

premises of the Applicant, all the liabilities shall have to be borne by the applicant.

15) That I/We undertake 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 my/our premises.

16) That I/We undertake to 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.

17) That the Licensee shall have the right to supply electricity to other consumers from the

service line or apparatus installed on my/our premises as per Supply Code/HPERC

Regulations.

18) That I/We undertake/declare that I/We shall not extend /sub-let this electricity supply to

any other premises. In case found doing so, HPSEBL will be at liberty to take action as per

provisions of Electricity Act,2003 and rules/regulations/codes notified by HPERC.

19) That the industry/trade for which electricity connection is being applied 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 premises. In case, at a later date it is found otherwise, then electricity supply

would immediately be disconnected by the Licensee without any reference/notice to the

Applicant.

20) That grant of the applied electricity connection will not confer any legal right for

regularization of building/land use in respect to the electricity connection provided at the

Applicant’s premises. Further, it shall also not confer any right in favour of Applicant to

have permanent electricity connection.

Signature of applicant

FORMAT-I(Page-3)

21) That the Licensee shall be at liberty to adjust any dues including electricity consumption

charges against the security 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.

22) That the licensee shall be at liberty to transfer the dues remaining unpaid by the

Applicant, after adjusting the security 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.

23) That the applicant would allow clear and unencumbered access to all authorized officials

of the Licensee to the premises of the Applicant for the purpose of meter reading,

maintenance, inspection, checking, testing etc.

24) That I/We have clearly understood that if the above statements prove to be false or

incorrect or on receipt of a reference from concerned statutory authority/ law enforcing

agency regarding sealing/demolition/vacation of the premises the electricity connection

can be disconnected and the meter /service line can be removed by HPSEB Ltd. without

any further notice to me.

25) That all the details furnished in the Application and Agreement Form are true to the

applicant’s knowledge. If any information is found incorrect/concealed at later stage, then

the Licensee will have the right to withhold/disconnect supply without any notice, as the

case may be and forfeit the securities deposited with the Licensee and the Licensee will

have right to adjust all dues against the security deposits.

26) The above declarations given by the applicant, shall be construed to form integral part of

Application & Agreement for supply of electricity.

Signature of applicant

VERIFICATION:-

I/We, the above mentioned applicant further declare that the contents of my/our above

undertaking are true to the best of my knowledge and belief and nothing has been concealed

therein.

Signed and verified at _____________on dated ________________

Signature of applicant

SIGNED AND DELIVERED

In presence of Witness:

Signature of the Witness

Name & Address of Witness

______________________________________

______________________________________

______________________________________

Identity Proof of Witness:

* The clauses which are not relevant for a particular category may be struck off on case to case

basis.

HPSEBL Form CS-10( Page-1)

HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED (A STATE GOVERNMENT UNDERTAKING)

WIRING CONTRACTOR'S TEST REPORT

AND

HPSEBL'S INSTALLATION TEST ORDER

Name.......................................................................

Particulars Address....................................................................

of Application/ Description of premises ............................................

Consumer Application No........................Account No. ....................

Owner of Premises( In case applicant is not owner, relevant

documents be attached)..........................................................

FROM

Name & ..........................................................................................

Details of Wiring Contractors..........................................................

Wiring License No. ....................... Dated........... Valid till……………(date)

Contractor

To

Assistant Engineer/Assistant Executive Engineer /Executive Engineer, Himachal Pradesh State Electricity Board

Electricity Sub-Division.............................

REPORT

Please note that the electrical installation belonging to the above consumer, as

detailed on page 2 and 3, is now ready for the HPSEBL's test.

The installation was tested by me/us on....................................... (date) and the

insulation resistance was as shown at page 2 and 3.

Dated:_ _/_ _/_ _ _ _/ Wiring Contractor's signature..............................

SCHEDULE OF ENERGY CONSUMING APPARATUS TO BE CONNECTED HPSEBL Form CS-10( Page-2)

The Size of connecting wires Between Meter Board & Dated Signatures of the Distribution Boards ……………. Wiring Contractor ……………….. P.T.O.

No

. of

Cir

cuit

s (l

eft

to R

igh

t) o

n D

istr

ibu

tio

n B

oar

d

Siz

e o

f C

on

du

cto

r

Description Lamps / Tubes Etc.

Fans, Cookers, Refrigerators etc.

Motors

To

tal c

on

nec

ted

load

of

each

cir

cuit

(in

kW

)

INSULATION RESISTANCE [MEGA-OHMS]

Ear

th R

esis

tan

ce(i

n O

hm

s)]I

n c

ase

of

Med

ium

,

HT

&E

HT

inst

alla

tio

ns

No. Total kW

No. Watts each

Total kW

No. h.p/ kW each

Total kW Wiring Contractor’s Test

HPSEBL Test

1-Ø 3-Ø 1-Ø 3-Ø

Bet

wee

n

Co

nd

uct

ors

Bet

wee

n

Co

nd

uct

ors

& e

arth

Bet

wee

n

Co

nd

uct

ors

Bet

wee

n

Co

nd

uct

ors

& e

arth

Bef

ore

co

nn

ecti

ng

an

y

lam

p o

r ap

par

atu

s

Bef

ore

co

nn

ecti

ng

an

y

lam

p o

r ap

par

atu

s

Aft

er c

on

nec

tin

g a

ny

lam

p o

r ap

par

atu

s

Bef

ore

co

nn

ecti

ng

an

y

lam

p o

r ap

par

atu

s

Bef

ore

co

nn

ecti

ng

an

y

lam

p o

r ap

par

atu

s

Aft

er c

on

nec

tin

g a

ny

lam

p o

r ap

par

atu

s

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

No.1

No.2

No.3

No.4

No.5

No.6

And so

on ……..

HPSEBL Form CS-10( Page-2A)

The Size of connecting wires Between Meter Board & Dated Signatures of the Distribution Boards ……………. Wiring Contractor ………………..

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

No.1

No.2

No.3

No.4

No.5

No.7

..

..

..

..

..

..

..

..

HPSEBL Form CS-10( Page-3)

A. DETAILS OF SHUNT CAPACITORS INSTALLED, IF ANY:

(a) Serial No.

(b) Capacity

(c) ISI marked

(d) Make

(e) Date of Installation

(f) Other particulars

B. DETAILS OF TRANSFORMERS INSTALLED IN CASE OF HT CONSUMERS [FURNACE/Rolling Mill TRANSFORMERS],

PARTICULARS BE INDICATD HERE:

(a) Serial No.

(b) Capacity

(c) Voltage Ratio

(d) Make

(e) Date of Installation

(f) Other particulars

Dated Signatures of the Wiring Contractor

With Seal

Note: - Details of load, shunt capacitors and transformer particulars be verified by the HPSEBL’s Officials while verifying test report.

HPSEBL Form CS -10(Page-4)

HPSEBL’S INSTALLATION TEST ORDER

(A)

The Junior Engineer/ Addl. A.E,

Electrical Section, HPSEBL_______________ Please test the installation detailed on pages 2, 2A and 3, filled in columns 18 to 22 and report as below. It may, however, be ensured that the intimation regarding the date on which you intend to visit the consumer’s premises for the above said purpose is given to the consumer or his representative well in advance, so as to enable him to be present at the time of Inspection. Also please ensure that for any subsequent visit for testing of the said installation necessitated by the consumer on the previous visit or due to defective installation, the consumer is asked to pay the requisite charges as per the schedule of general charges and receipt No./date vide which the charges are paid by him is quoted in the report.

Assistant Engineer /Assistant Executive Engineer Dated ………………………….

(B) REPORT (1) Above installation was tested by me on (date)…………………………..in the presence of

consumer (or his representative) and the insulation Results were as shown on page 2 , 2A and 3. The following defects were found in the installation.

i) Whether Insulation Resistance Satisfactory…………………………………

ii) Other Defects, if any (a)…………………………………………………….

(b)…………………………………………………… (c)……………………………………………………

(2) (a) The above installation was tested by me on my first visit. OR

(b) The installation was tested by me on my subsequent visit for which the consumer deposited the amount of Rs…………………….as per the schedule of general charges vide Receipt No……………………….Date………………

Signature of Consumer Name( in case of representative): ……………… Dated:_ _/_ _/_ _ _ _/ Signature Junior Engineer/Addl. A.E. Dated:_ _/_ _/_ _ _ _/

HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED (A STATE GOVERNMENT UNDERTAKING)

ACKNOWLEDGEMENT

Received the application for new/ additional load as per Serial No. ..............Dated……... as per details

given below:-

1) Name of applicant: ………………………………………………….

2) Address where connection is required………………………………………………………………………..

…………………………………………………………………………………………………………………………………

3) Load applied for ………………….(kVA) CD with …………………..(kW) connected load.

Rubber Stamp

Signature of Distribution Licensee’s representative

Name & Designation:

Checklist for Consumer

Sr. No.

Description Please Tick

A) General

i) Application and Agreement Form (A&A Form) duly completed and signed by the applicant.

ii) Test Report duly filled and signed by licensed Electrical Contractor.

iii) Crossed Non-Judicial Stamp paper of Rs.10/- attached with A&A form

iv) Valid Power Availability Certificate issued by HPSEBL (in case contract demand for new and additional load of more than 100 kVA)

v) Self Certified signed Undertaking attached

vi) Approval of Chief Electrical Inspector in case of HT/EHT installation energisation.

vii) Brief Project report [In case of industrial connection]

viii) Process Flow[In case of industrial connection]

ix) Copy of Certificate of registration in case of Companies/Firms etc.

B) Identity/Ownership

i) Identity Proof

PAN

Adhaar Card

Driving License

Passport

Voter ID Card

ii) Proof of Ownership

Revenue Papers for Land/Building/premises

Sale Deed

Lease Deed

C) Authorized Signatory [In case of Companies only]

i) Resolution of Board of Directors for authorized signatory on behalf of company

D) NOC from Local Bodies [ Mandatory only in case of applications for electric connections for the premises falling under planning areas, Municipal Corporations, Nagar Panchyats and other local bodies where TCP Act ,1977 is applicable] i) NOC from local bodies enclosed

E) Charges to be deposited[Ref. HPERC Regulations 419/2012,HPERC Security Deposit Regualtions,2005]

i) Initial Security

ii) Normative IDC

iii) Cost of Service Line or Departmental Charges as the case may be.