Form No. JSEB/
Jharkhand State Electricity Board
REQUISITION FORM FOR SUPPLY OF ENERGY
(Requisition Form downloaded from the website will also be accepted)
(This form is available free of cost)
Application fee receipt No.
Photograph of the
applicant with
Signature
Date
Application No.
To,
THE ASSISTANT ELECTRICAL ENGINEER
ELECTRIC SUPPLY SUB-DIVISION
………………………………………………….
………………………………………………….
Sir,
I/We hereby require you, in accordance with 43 (I) of the electricity Act’2003, to supply energy for
the premises owned/occupied by me/us and situated within the area of supply of the Jharkhand State
Electricity Board.
I/We further require you to supply me/us with the necessary meter/meters on hire in terms of section
55 of the Electricity Act’2003. I/We agree to give you such security as may be required for the price of the
meter/meters, whenever called upon to do so.
1. Particulars of the Applicant/Applicants:
Name: Mr. /Mrs.
on his own
behalf and on behalf of other members of joint family namely
Occupations
designation
Son/Wife/Daughter of
Permanent resident of Village/Town
P.O.
P.S.
Dist.
Tele. No.
E. mail.
Aadhaar Card (UID) no.
OR
2.
a Partnership
Firm/ Joint Stock Company duly registered under Indian Partnership Act 1932/ Indian Companies Act, 1956
bearing Registration No
of
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with the Registrar of Firm/ Registrar of joint Stock Companies at
in the state of
and having its registered
office at
acting through its
namely Mr./Ms.
Son/Wife/Daugher of
Permanent resident of village/Town
P.O.
P.S.
Dist.
…………………….
in the State of
& presently residing at Village/Town
P.O. …………………………………………… P.S. ………………………………
Tel.No.
Dist. .
E. mail
(Note: Portions not needed should be struck off)
3. Particulars of the premises where supply is required
(a) (i) name of the premises, if any
(ii) Holding no.
(iii) Plot no
(iv) Khata no
(v) Ward no
(vi) Road no
(vii) Mohalla
(viii)Village
(xi) P.O.
(x) P.S
(xi) Sub Div
(xii) Dist
(Strike out the words not applicable)
(b) Nature of right title, and possession of the Consumer of above given premises
(c) Name and address of the owner of the premises, if applicant is not the owner
Son/Wife/Daughter of
Permanent resident of village/Town
P.O.
P.S.
in the State of
Dist.
……………………
& presently residing at Village/Town
P.O.
Dist.
P.S.
Tel.No.
E. mail
(Note: Portions not needed should be struck off)
(d) Written permission of the Landlord tendered.
(Write ‘Yes’ ‘No’ or Not applicable, as the case may be)
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Note:- (i) Proof of legal occupancy in the form of copies of sale deed or partition deed or succession
certificate or power of attorney or lease/rent agreement or allotment order or in case of agricultural
connection “Khata Nakal” giving Khesra no. to be submitted with the requisition form.
(ii) Photo copy of Aadhaar Card to be submitted with the requisition form.
(iii) In case of partnership firm, partnership deed, authorization in the name of the applicant for signing the
requisition form and agreement be submitted with the requisition from.
(iv) In case of Public and/or Private Limited Company, Memorandum and Articles of Association and
Certificate of incorporation together with an authorization in the name of the applicant for signing with the
requisition form and the agreement.
4. I/We require Service Connection for –
Purpose under tariff
5. The following are my/our requirements.
Lamp/Fan/Plugs
Description No. Wattage Total
wattage
Appliances
(Heater,Oven,Refrigerater,Cooler, A/c,
M/c)
Description No Wattage Total
wattage
Motors
HP
No.
Total
HP
(In case the space is insufficient, please attach details on separate sheet)
Total connected load applied for …………………………… KW/HP/KVA
6.
7.
(A) This requisition is for:
a.
b.
c.
d.
e.
f.
g.
A new service connection
Temporary Service connection
Shifting of service connection no.
An extension of any existing installation from service no.
Seasonal connection
A reconnection of Service No………………………………………………………………
change of name from
Service connection no
h. Enhancement/Reduction of load of service no………………..
from …………………
KW/HP/KVA to
KW/H/P/KVA
i. Change of tariff from…………………
to ……………………….
j. A sub service from the existing service no.………………………………….
(B)
a. Particular of previous connection, if any, to the premises described earlier………………
b. Relationship with previous consumers…………………………
c. Whether the applicant undertakes to clear the past liability on the previous connection in the
premises…………………………………….
d. The system of wiring will be
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e. The wiring will be carried out by:
Name
Address
f. Whether the applicant wants to carryout the works of laying service line and/or dedicated
distribution facility for the electricity supply requisitioned
Applicant’s Signature
and his Present address
Dated the………Day of…………200…..
NOTE:
(1) The applicant is requested to complete the clause referring to this requisition and to strike out
the clauses which are not applicable to him/ her.
(2) Under provision of law, the Board shall not be bound to comply with any such requisition
unless and until the person making it.
(a) Within fifteen days after the service on him by the Board of notice in writing in this behalf,
complies with the provisions laid down in the electricity supply code 2005 and tender to the
Board a written contract in approved form duly executed and with sufficient security binding
himself to take supply of energy for not less than two years to such amount as will assure to the
Board at the current rates charged by it an actual revenue not exceeding 15 percent of the Cost
of the service line required to comply with their requisition, and
(b) If required by the Board so to do pays to the Board the cost of so much of any service line as
may be laid down or placed for the purpose of the supply upon the property in respect of which
the requisition is made and of so much of any service line as it may be necessary for the said
purpose to lay down or place beyond one hundred feet from the Board’s distributing mains,
although not on that property.
DECLARATION
1. I/We hereby declare that I/We desire to have and agree with the Board to make supply of energy for the
above mentioned purpose for a period of not less than two years from the date of commencement of the
supply and to be bound by the Provisions and Rules made under the Electricity Act, 2003 and by the
appropriate tariffs applicable to me/us and conditions of supply as are from time to time inforce.
2. I/We further hereby agree to pay every sum that may become due from me/us for the energy or other
charges of the Board to the officer authorized by the Board to receive it and in event of non-payment of
the said sum, it shall be recoverable from me/us as public demand under the Bihar and Orissa Public
Demand Recovery Act’1944.
3. I//We further agree that no unauthorized addition/alternation to the equipment or unauthorized use of
electricity will be carried out by me/us.
4. I/We undertake to intimate the Board, as per the provisions in the electricity supply code-2005, whenever
I/We intend to vacate the premises for which the electric connection is being taken.
(Affix Stamp)
Applicant’s Signature
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