APPLICATION FORM-LT NEW SERVICE CONNECTION (FOR DOMESTIC,NON-DOMESTIC,INDUSTRIAL CATEGORY and AGRICULTURE & ALLIED ACTIVITIES)
CONNECTION DETAILS
NAME OF PERSON/ORGANIZATION*
Relative/Director Name*
Relation/Designation
SELECT
DIRECTOR
FATHER
HUSBAND
MANAGER
MOTHER
OTHER
Relation Name
IS APPLICANT UNDER BPL CATEGORY
SELECT
NO
YES
ENTER BPL NO
APPLICANT CATEGORY
SELECT
GENERAL
SC
ST
OBC
CONNECTION TYPE
SELECT
PERMANENT
TEMPORARY
CONNECTION CATEGORY
SELECT
CONNECTION PURPOSE
SELECT
CONNECTION PHASE
SELECT
SINGLE
THREE
CONNECTED LOAD(KW/HP)
SELECT
KW
HP
Capacitor
SELECT
YES
NO
SELECT DISTRIBUTION CENTER
DISTRICT
SELECT
DIVISION
SELECT
DC
SELECT
COLONY
SELECT
NAME OF COLONY
DISTANCE FROM POLE
up to 45 Mtr
above 45 Mtr to 500 Mtr
above 500 Mtr to 1 KM
above 1 KM to 1.5 KM
above 1.5 KM to 2.0 KM
above 2.0 KM to 2.5 KM
above 2.5 KM to 3.0 KM
above 3.0 KM to 3.5 KM
above 3.5 KM to 4.0 KM
above 4.0 KM to 4.5 KM
above 4.5 KM to 5.0 KM
AREA TYPE
SELECT
URBAN
RURAL
ADDRESS DETAILS WHERE NEW CONNECTIONS IS BEING APPLIED FOR
TYPE OF PREMISE
SELECT
Individual
Multi Consumer Complex
BUILT-UP AREA (SQ.FT)
PLOT AREA (SQ.FT)
HOUSE NO/PLOT NO/KHASRA NO
AREA/COLONY
CITY/TOWN/VILLAGE
DISTRICT
SELECT
ANUPPUR
BALAGHAT
CHHATARPUR
CHHINDWARA
DAMOH
DINDORI
JABALPUR
KATNI
MANDLA
NARSINGHPUR
PANNA
REWA
SAGAR
SATNA
SEONI
SHAHDOL
SIDHI
SINGROULI
TIKAMGARH
UMARIA
VIDISHA
PINCODE
MOBILE NO
WHATSAPP NO
EMAIL ID
RESIDENCE ADDRESS
(If Above Address Details and Residence Address are same)
HOUSE NO/PLOT NO/KHASRA NO
AREA/COLONY
CITY/TOWN/VILLAGE
DISTRICT
PINCODE
MOBILE NO
BANK ACCOUNT DETAILS
BANK NAME
SELECT
ABHYUDAYA COOPERATIVE BANK LIMITED
ABU DHABI COMMERCIAL BANK
ALLAHABAD BANK
ANDHRA BANK
AXIS BANK
B N P PARIBAS
BANK OF BAHARAIN AND KUWAIT BSC
BANK OF BARODA
BANK OF CEYLON
BANK OF INDIA
BANK OF MAHARASHTRA
BASSEIN CATHOLIC COOPERATIVE BANK LIMITED
CANARA BANK
CATHOLIC SYRIAN BANK LIMITED
CENTRAL BANK OF INDIA
CHINATRUST COMMERCIAL BANK LIMITED
CITI BANK
CITIZEN CREDIT COOPERATIVE BANK LIMITED
CITY UNION BANK
CITY UNION BANK LIMITED
CORPORATION BANK
CREDIT AGRICOLE CORPORATE AND INVESTMENT BANK CALYON BANK
DCB BANK LIMITED
DENA BANK
DEPOSIT INSURANCE AND CREDIT GUARANTEE CORPORATION
DEVELOPMENT CREDIT BANK
DHANALAKSHMI BANK
DHANLAXMI BANK
DOMBIVLI NAGARI SAHAKARI BANK LIMITED
FEDERAL BANK
FIRSTRAND BANK LIMITED
HDFC BANK
HSBC BANK
ICICI BANK
IDBI BANK
INDIAN BANK
INDIAN OVERSEAS BANK
INDUSIND BANK
ING VYSYA BANK
JANAKALYAN SAHAKARI BANK LIMITED
JANASEVA SAHAKARI BANK LIMITED
KAPOL COOPERATIVE BANK LIMITED
KARNATAKA BANK LIMITED
KARUR VYSYA BANK
KOTAK MAHINDRA BANK LIMITED
MAHANAGAR COOPERATIVE BANK
MAHARASHTRA STATE COOPERATIVE BANK
MASHREQBANK PSC
MIZUHO CORPORATE BANK LIMITED
ORIENTAL BANK OF COMMERCE
PUNJAB & SIND BANK
PUNJAB NATIONAL BANK
SOUTH INDIAN BANK
SYNDICATE BANK
UCO BANK
UNION BANK OF INDIA
UNITED BANK OF INDIA
VIJAYA BANK
YES BANK LTD
STATE BANK OF INDIA
NARMADA JHABUA GRAMIN BANK
IDFC BANK
BANDHAN BANK
JILA SAHKARI KENDRAIYA BANK MARYADIT
LAKSHMI VILAS BANK
DEUTSCHE BANK
AU SMALL FIN BANK
INDORE PREMIER CO-OP BANK LTD
RATNAKAR BANK LIMITED
SHIVALIK MERCANTILE CO-OPERATIVE BANK LTD
STANDARD CHARTERED
NAGPUR NAGRIK SAHAKARI BANK LTD
MADHYANCHAL GRAMIN BANK
BANK ACCOUNT NO.
IFSC CODE
PAN CARD NO/TAN NO
DO YOU HAVE GSTIN NO :
SELECT
YES
NO
GSTIN NO
ID PROOF
ID PROOF TYPE
SELECT
Aadhar Card
AADHAR CARD NUMBER
UPLOAD DOCUMENTS
SELF PHOTO
Maximum upload size is 3 MB.
AADHAR CARD
Maximum upload size is 3 MB.
OWNERSHIP PROOF
Maximum upload size is 3 MB.
BANK PASSBOOK
Maximum upload size is 3 MB.
AGREEMENT
I accept the term & condition
Submit
Reset