APPLICATION FORM FOR NEW CONNECTION LT

**Marked Fields are Mandatory

NAME OF APPLICANT   **
CURRENT ADDRESS OF APPLICANT   **
ADDRESS OF PREMISES   **
LOCATION OF PREMISES  **
LAND MARK  **
TELEPHONE NO.  
MOBILE NO.  **
ENTER PAN CARD NO OF APPLICANT  
LOAD APPLIED IN KW  **
NEIGHBOUR CONNECTION DETAILS (IVRS / NAME / PREMISES)  
CONNECTION TYPE

Permanent   Temporary   **

APPLICATION FOR DC
SELECT CIRCLE   **
SELECT DIVISION
  **
SELECT DISTRIBUTION CENTER
  **
TYPE OF CONNECTION REQUIRED    **
PURPOSE OF CONNECTION      **