| 1. | Name of Company/Zone/Circle: |  | 
                                
                                    | 2. | Name of City/District: |  | 
                                
                                    | 3. | Name of the Consumer: |  | 
                                
                                    | 4. | Father/Husband's Name: |  | 
                                
                                    | 5. | Complete address where connection is situated: |  | 
                                
                                    | 6. | Mobile No: |  | 
                                
                                    | 7. | Name of Distribution Division (Refer Electricity Bill): |  | 
                                
                                    | 8. | Total Sanctioned Load (In KW/KVA/HP) (Refer Electricity Bill): |  | 
                                
                                    | 9. | Supply Type (Refer Electricity Bill): |  | 
                                
                                    | 10. | Tariff (Refer Electricity Bill): |  | 
                                
                                    | 11. | Account No. (Refer Electricity Bill): |  | 
                                
                                    | 12. | Details of Fee (Refer FAQ): |  |