Change of Name-Legal Heir

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Connected

App No

For Office
Use Only
Con No load/ Con
Date
Demand
.............. Date of change of
Purpose Tariff
kW/kVA ownership Affix recent Passport size
Photograph of applicant /
Kerala State Electricity Board Limited authorised signatory

Application for Change of Name


(For transfer of ownership to Legal Heir)
* This form is to be used by Prospective Consumer

I am the legal heir of ................................................................................................. (name of Registered Consumer), having


Service Connection under Electrical Section .............................................................. with Con No / Code ..................................
I request that the said service connection be transferred to me.

Particulars of Applicant Particulars of Owner


(Proposed Consumer) (if the applicant is not the owner of the building)

Name

Bldng No. / Street

1 Place / Land mark


District / Pin Code

Land
Phone No.
Mobile

E mail
If connection is Name of Organisation
2 required for an
Organisation Designation of Applicant

3 Reason for Transfer of Connection

4 Connected load kW Contract Demand kVA

5 Status of applicant (√) Owner Tenant

If applicant is tenant / occupier * (Proof of ownership to be produced separately)

I …………...………....…………………...........…............….. .........................................being registered title holder and the owner / joint


owner of property comprised in Sy No ............................ of ......................................... Village, bearing building no. ...........................of
.................................................................. (local body) do hereby give my / our consent to Sri / Smt
......……..................…...…………………..........., who is a tenant / occupier of the above premises to wire and avail service connection
from KSEB Ltd in his name as consumer at the above premises. I/We shall inform KSEB as and when the premises is vacated.

Name & dtd signature of Name & dtd signature of Name & dtd signature of
owner first witness second witness

I, ………………………………………………………………, son/daughter of ………………………………………………residing in


………………………………………………… (Building No. & local body) …………………………...… Village ……………………….…
Taluk …………………….…. District hereby declare that I have attained 18 years of age, that the information provided in this application
is true to my knowledge, that there are no orders of Court / Govt restricting electricity connection in the premises, that I will remit
electricity dues during every billing cycle and also as and when demanded as per the applicable electricity tariff, and other charges,
that I will own the responsibility of security and safety of the meter, cut-out and the installation thereafter. I will not indulge in any
misuse of power and will take all necessary steps in the premises for the efficient use of power and to stop its wastage. I have read and
understood the Kerala Electricity Supply Code, 2014 and agree to abide by the conditions mentioned therein.

Date: Signature of the applicant / authorized signatory


Place: Name:
Acknowledgement

Ref No: ...............................................

Application of ....................................................................................(name of applicant), complete in


all respects, for change in name has been received at this office on ............................. (Date).

The above reference number is to be used for all future correspondence.

Signature of representative Seal of KSEB Ltd


Name and designation

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