(Form A-2) PASCHIM GUJARAT VIJ COMPANY LIMITED

1 (Form A-2) PASCHIM GUJARAT VIJ COMPANY LIMITED Application form- New connection/ Load enhancement/ Load reduction/ Change of name (High Tension/ Extra High Tension Service) Note- (1) Applicant is requested to fill his/her name with all details clearly and to sign. Further details available on website To, _____ Engineer, PGVCL _____ Office I / We hereby request you for New connection/Alteration in Existing Connection/ Temporary Connection to supply electrical energy at High Voltage/ Extra High Voltage for the premises owned / occupied by me/ us.

2 1 Name of the Applicant/Organisation: 2 Name of father/husband/Director/Partner /Trustee: 3 Connection Type New Transfer Addition / Reduction in Load Name of the original Consumer: HT Connection No. Date of Application For Office Use Only Applicant s recent Passport size Photograph SR No & Date Application No. Consumer No. Contract Load Applicable Tariff 4 Address for communication 5 Address where the new connection is applied for/existing connection is required to be shifted (Indicate landmarks to identify the location) 6 Voltage at which supply is required (kV) (Please tick the category applicable) 11 kV 66 kV 132 kV 220 kV 400 kV 7 Type of supply (Permanent/ Temporary) 7 (a) If Temporary supply, specify period of requirement From (date): To (date).

3 8 Details of Contract Demand applied for (in kW/ kVA): 9 Power requirement in kW/kVA Existing C. D. Additional/ Reduction Revised C. D 10 Tentative date from which power supply is required 11 Purpose of Installation Manufacturing of goods/ Service 12 Category of tariff opted for 13 Basis for projection of Contract Demand- Diversity Factor assumed 14 Production capacity 15 Number of shifts working 16 Legal Status of the applicant (viz. Ownership/ partnership/ Private Public Society/ Govt Govt.)

4 Undertaking) New Connection Change in Contract Demand 16 (a) Registration No. and Date 17 Name of Institution developing Industrial Premises 18 Possession Letter or No-Objection Certificate Number: Date: 19 Issued by the Institution (attach a copy) 20 Whether the above unit ever operated at some other place or applied for connection? (If yes, please provide details) (a) Sanctioned Load: (b) Connection No.: (c) Arrears of payment (if any): 21 If electricity connection for the premises was requested in the past?

5 (If yes, please provide details) (a) Sanctioned Load: (b) Connection No.: (c) Arrears of payment (if any): 22 Status of land acquisition 23 Whether the requisite consent/ NOC (if applicable as per the list of Pollution Control Board) has been obtained from_____ as per statutory requirements (If yes, attach a copy) 24 Any electricity dues outstanding in licensee s area of operation in consumer s name: Yes/ No 25 Any electricity dues outstanding for the premises for which connection applied for : Yes/ No 26 Any electricity dues outstanding with the licensee against any firm with which the consumer is associated as an Owner, partner, Director or Managing Director: Yes/ No (For questions 24,25 and 26 if the answer is Yes in any case, please provide details on a separate sheet) Declaration I/ We hereby declare that (a) The information provided in this application is true to my knowledge.

6 (b) I/We desire and agree with the distribution licensee to avail power supply for the above mentioned purpose and of the load shown in this application form for the period of two years from the first day of the month next to date of commencement of power supply by the licensee. (c) I/ We have read the GERC ( GUJARAT Electricity Supply Code) and agree to abide by the conditions mentioned therein. (d) I/ We will deposit electricity dues, every month, as per the applicable electricity tariff and other charges.

7 (e) I/ We will own the responsibility of security and safety of the meter and metering equipments and the installation thereafter. Date: Signature of the consumer/ Authorized Signatory Place: Name: In case of Firm/ Partnership/ Ltd. COMPANY , Power of attorney Holder s signature must be supported by official seal Note: The following documents shall be attached with the application form: 1. Proof of ownership of the premises 2. A map indicating the proposed location of the plant/ office and the point where supply is required.

8 The map should also clearly show all the boundary of the premises, the public road/s (with name/s of the road/s) inside and outside of the premises/ land, roads, lands, roads belonging to outside agency innerving the premises, if any. 3. License/ NOC from statutory authority, if required or a declaration by the applicant that his connection does not fall under the requirement of NOC under any statue. 4. In case of a proprietary firm, an affidavit to be submitted stating that the applicant is the sole proprietor of the firm.

9 5. In case of partnership firm, partnership deed. 6. In case of LIMITED COMPANY , Memorandum and Articles of Association and Certificate of Incorporation. 7. Proof of permanent residential address of the consumer and PAN Number, if any. If there is any change at a later date, the same shall be intimated by the consumer to the licensee immediately. 8. Letter of intent for production/ enhancement in production may be furnished. 9. List of equipments proposed to be installed along with the expected load.

10 10. Resolution for authorized signatory. 11. Registration from Industries Department. 12. Extract of project report relevant to power and process requirements ( in case of industries) 13. Copy of the relevant section of the current tariff order that provides details of the tariff category opted by the consumer and duly signed by him. This will be appended with the agreement after completion of formalities.