EPDCL Load Load Change Application Form Paste here your recent

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EPDCL Load Change Application Form
Paste here your
recent passport
size photograph
Service Change Type: - Load Change
Service Connection Number*:: ___________
_______________________________________________
Circle Name*: Eluru Rajahmundry Srikakulam Visakhapatnam Vizianagaram
Area Code*: ________________________ Section Name*: _____________________________
Consumer Details:AADHAR Card No: _____________________________
________________Consumer name *: ______________________________________
_____________________
Consumer Surname*: ____________________
_________________ Consumer Father Name*: _____________________
____________________
Social Group *: Others S.C S.T
If Others: __________________________________________
_____________________
Connection Type*: Domestic Commercial Commercial – Hoardings 6A – Street Lights 6B – Public Water Works
General Issues Religious Places (Temples, Church, Mosque, Govt.Schools etc)
Location Type*: Urban Rural
Location Name*: __________________________________________
___________________
Location of Premises:House No*: ____________________Locality
Locality*:_________________________________________________________
____________________________
Circle*: _________________________ Division
Division*: _________________________ Sub Division*:: ________________________
__________
Pin Code: _________________
Department Type
Type*: Non Government State Government Central Government
Phase Type*: Phase -1 Phase -3
Estimation Type*: with Estimate without Estimate
Load Details:S.No
Category
Changed Load: ______________________
Sub Category
No of Items
Reason for Change: _______________________________________________
Address for Communication:Door No: _________________ Locality/Land Mark: _____
___________________________________________________________
_____________________________
State*: _________________________
____________ District
District*: _________________________ Mandal*: ______________
____________________
Village/Ward*: ___________________Pin
_Pin Code: _________________Mobile Number
Number*: _________________
_________
Email ID: _________________________________________
_____________________
Informant Details:Informant Name*: ___________________________
_______________________________________ Informant Relation*:: ____________________
_________
Delivery Type*: At Kiosk
Security Deposit (Available) *: ______________________________________
ID Proof*: Aadhar Card Copy
Ration Card Copy Pan Card Copy Electoral Card Copy
Document List: - (NOTE: All Upload Documents are in PDF Format Only)
Application Form* Latest Power Bill with Receipt* Category and Load Change Undertaking Form*
Form
Note: Please upload Application Form and Above Documents as a single file
ID Proof *
Applicant’s Signature