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A-1 Application Form
Service Request ID [
]
Instructions for filling the form:
Kindly fill complete and correct information in relevant column.
Applicant will be solely responsible for incomplete or incorrect information
Applicant is requested to note the request id for future tracking of the application.
Please provide the correct nearest consumer number, so that your request can be assigned to proper MSEDCL field office.
The applicant will be contacted by MSEDCL officer /Call Center Representative on email/mobile provided by you for verification.
Please download
New Connection Form
and keep ready duly filled in and signed with required documents (which are mentioned on A1 Form).
Click
here
for help regarding filling New Connection Request.
Email address, mobile number are mandatory
Request to apply for New Industrial Connections through GoM's MAITRI portal.
General Information
Non Industrial
Industrial
Consumer Category:
*
-- Select --
1-LT-SUPPLY
2-HT-SUPPLY
3-EHV
Supply Type:
*
-- Select --
SINGLE-SINGLE PHASE
THREE-THREE PHASE
HT-HT SUPPLY
Service Requested:
*
-- Select --
001-New Connection (Permanent)
002-New Connection (Temporary)
Application Date:
Application Details
First Name:
*
-- Select --
Mr
Mrs
Ms
M/S
Middle Name:
Last Name:
Occupation:
-- Select --
SERVICE
PROFESSION/BUSINESS
OTHERS
Applicants Classification:
*
-- Select --
1-Open
2-OBC
3-SC
4-ST
5-BPL
6-OTHER
Gender:
*
-- Select --
1-Male
2-Female
3-Organization
Address at which supply is required(Please enter complete details)
Plot/ Flat No/ Survey No / House No / Building Name:
*
Society Name:
*
Street/Landmark:
Village:
*
Taluka / City & District:
*
PinCode:
*
Email:
*
Mobile:
*
Phone:
Nearest Consumer No:
*
Aadhaar Number:
Billing Details
Click here if billing Address same as Meter Address
Plot/ Flat No/ Survey No / House No / Building Name:
*
Society Name:
*
Street/Landmark:
Village:
*
Taluka / City & District:
*
PinCode:
*
Email:
*
Mobile:
*
Phone:
Type Of Premises:
*
-- Select --
1-OWNED
2-RENTED
3-LEASE
4-LIS/OTHERS
Others:
To be filled if Type Of Premises selected is OTHERS.
Consumer Sub Category:
*
-- Select --
30-PWW
40-Residential
50-Commercial
70-LT powerloom
80-Street Light
90-Agriculture
91-LT poultry
92-LT Advertisement and Hoarding
93-LT Precooling
94-LT temporary Religious
95-LT temporary others
165-Temp-Construction
166-Crematorium And Burial
167-Public Services
207-LT IV A AG ZONE 1
209-LT IV A AG ZONE 2
Others:
Owner Information
In case of premises on Rent or Lease or not owned by applicant
Name of the Owner:
Plot/ Flat No/ Survey No / House No / Building Name:
Lane/ Street Landmark:
Village/City:
Pin code:
Phone No :
Mobile No:
Requested Load / Contract Demand
Requested Load:
*
KW
HP
Contract Demand:
*
KVA
Extension/ Reduction
For Extension/ Reduction of Load :
Existing Load:
*
KW
HP
Revised Load:
*
KW
HP
Extension/ Reduction
For Change in Contract Demand :
Existing Contract Demand:
*
1 - KVA
Total Contract Demand
*
1 - KVA
I hereby declare that
I will abide by the provisions of Electricity Act 2003 and Maharashtra Electricity Regulatory Commission (Electricity Supply Code and other conditions of Supply) Regulation 2005.I will further abide by rules & regulations issued by regulatory bodies & MSEDCL from time to time.. I will pay the electricity bill as per prevailing MSEDCL Tariff. If the premises is declared unauthorized then at the time of vacation by competent authority, MSEDCL will have liberty to remove the electric connection immediately.
The above information is true and if any false information is observed, I / we will be responsible for the consequence thereof.
I/ we agree to the terms and conditions
Place:
*
Submit
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