ONLINE APPLICATION FORM - NAME CHANGE

APPLICATION NO : REQUEST YET TO BE

Details of Existing Owner

Existing Consumer Number

103320841

Name of the existing consumer

MR. SUNIL TYAGI

Address of existing connection

PLOT NO 73 A G/F ,MOHAN GARDEN,DEFENCE ENCLAVE ,UTTAM NAGAR ,NEAR KALI MAA KA MANDIR
New Delhi 110059
Mobile: 93******11
Email: SU****************OM

Details of New Owner

Name

VIDYA NAND PODDAR

Mobile Number

93******11

E-mail id

SU****************OM

Important Documents
 Important Note :

For ownership proof - Sale Deed/Conveyance Deed/Allotment Letter/Valid Lease agreement/Mutation certificate issued by Govt
authority/sub division agreement/GPA.
Ensure all pages (front and back side) of the relevant document are uploaded.
All uploaded documents should be self-attested by applicants(s) on photocopy of original documents.
All uploaded documents should be clear & readable.
Uploaded documents should be in Pdf format . Ownership proof document within size limit of 25 MB & other documents within size
limit of 5 MB .

 Identification Proof (Self Attested) (Anyone in PDF Format)*

ID Proof Type. *

PAN Card

ID Proof Doc No. *

CUMPP3987P

pan card-1.pdf

 Ownership Proof (Self Attested) (Anyone in PDF Format)*

SALE DEED.pdf

Documents CheckList

 Do you want to opt for voluntary subsidy benefits - Yes/No? Yes No

SELF - DECLARATION FORM / UNDERTAKING

I, VIDYA NAND PODDAR Son/Daughter/Wife of RAM VINAY PODDAR Resident of PLOT NO 73 A G/F,MOHAN GARDEN,DEFENCE
ENCLAVE,UTTAM NAGAR,NEAR KALI MAA KA MANDIR, New Delhi, 110059 (hereinafter referred to as "Applicant", which term shall mean
and include executors, administrators, heirs, successors and assigns), do hereby swear and declare as under:

Or
The , a company incorporated under the provisions of the Companies Act, 2013 or as amended, having its registered office at ____
(hereinafter referred to as "Applicant", which expression shall, unless repugnant to the context or meaning thereof, include its successors
and assigns), through its duly Authorized representative Mr. ____ do hereby swear and declare as under:

Or
A Sole proprietorship/ a partnership firm having its office at ____ (hereinafter referred to as the applicant which unless the context
otherwise provides includes its successors and assigns), through Mr. ____ , who is a partner or a duly authorized representative do hereby
swear and declare as under:

(a) THAT the Applicant is a lawful occupant of the premises at PLOT NO 73 A G/F,MOHAN GARDEN,DEFENCE ENCLAVE,UTTAM
NAGAR,NEAR KALI MAA KA MANDIR, New Delhi, 110059(hereinafter the "Premises").

(b) The applicant has deposited the scan copy of all requisite documents as specified in the application form.

(c) That the scan copies filed with the application form are made from the original by mechanical processes which in themselves ensure
the accuracy of the copy and the applicant has himself compared the said scan copies with the original of said documents.

(d) That the applicant is in possession of the original of all the documents as filed with the application and shall submit/produce (as the
case may be) as and when demanded by BYPL.
(e) That the certificates submitted by applicant with the application form have been issued by the respective authorities and the applicant
has secured all those certificates in adherence of due process of law.

(f) That the applicant confirms that in case any of the undertaking being found false or the documents as submitted by the applicant along
with the application for electricity connection, being found forged, fabricated or secured in violation of the provisions of law or failure on
the part of applicant in production of the original documents within the strict timeline as notified by BYPL, than irrespective to the fact,
whether the applicant is guilty or not, BYPL shall be having full right to disconnect the said electricity connection, so released and the
applicant shall, at all times, keep BYPL, its officers/Directors/employees indemnified from all losses/damages/penalties/liabilities
associated with the installation of electricity connection, so released, based upon this instant undertaking and/or any other further breach
by the applicant to the terms/conditions/Rules/Regulations etc.

That I, the Applicant hereby agree and undertake:

1. That no objection certificate for seeking electricity connection from the co-owner has been obtained (in case the applicant is not
the sole owner of the premises).

2. To indemnify the licensee against all proceedings, claims, demands, costs, damages, expenses that the licensee may incur by
reason of a fresh service connection given to the Applicant.

3. That to the best of applicants knowledge, all electrical works done within the premises are as per Central Electricity Authority
(Measures relating to Safety and Electricity Supply) Regulations, 2023 as amended from time to time.

4. That the internal Wiring at the premises has been tested by a Licensed Electrical Contractor and the test certificate is available
with the applicant .
#In case of Government Quarters/Offices,

5. That the building has been constructed as per prevalent building Bye-Laws and the fire clearance certificate, if required, is available
with the Applicant.

6. *That there is a provision of lift in premises and the applicant has obtained the lift fitness certificate from the Electrical Inspector
for the lift in the said premises and the same is available with the applicant. (*If applicable)

7. That the applicant has applied for the correct category of tariff as per the applicable tariff schedule. For either of the following
categories of connection, the applicant has the relevant documents available with him.

A. Industrial (whichever is available)

a. (i) Valid Industrial License, or

(ii) Factory License, or

(iii) Household licence, or

(iv) Lal Dora Certificate in case of rural village, or

(v) Any other document authorizing the applicant to run the industry

OR

b. (i) Occupancy-cum-completion certificate from concerned Municipal Corporation or DDA, or

(ii) Consent to Establish from Delhi Pollution Control Committee(DPCC),or

(iii) Provisional Industrial License, or

(iv) Sanctioned building plan from concerned Municipal Corporation or DDA

B. Agricultural Consumers

i. Certificate of Residence from Block Development Officer,

(i) The Bazaari Receipt Number, or

(ii) No Objection Certificate for Khokha/Temporary Structure from concerned Municipal Corporation of Delhi or Delhi
Development Authority or any other concerned Land Owning Agency. Please provide following information in respect of
certificate available with the applicant. (Certificate No., issuing authority, date of issue, Purpose, validity, if applicable)

D. Charging station for electric vehicles - An undertaking by the applicant that the charging station for electric vehicles is as per
the Specifications as may be specified by Central Electricity Authority or Bureau of Indian Standards from time to time.
 8. *That the industrial connection is taken based on the documents mentioned in clause 7A(b) above and I shall obtain the valid
document as mentioned in clause 7A(a) above within a period of 3 months from issue of electricity changeRequestConnection. (*If
applicable)

9. That above referred applicable documents/certificates indicated at various points are available with me and can be inspected by
the Licensee at any time. In case of failure or reluctance to produce/allow the inspection of said documents/certificates the licensee
may disconnect the connection granted owing to such failure/, reluctance.

10. That I shall provide a legible and certified copy of any of above applicable documents to the licensee pursuant to order/request of
any government agency, judicial forum or any other authority seeking such information.

11. That my industry/trade has not been declared to be releasing obnoxious hazardous/pollutant by any government agency and that
no orders of any Court or judicial authority would be breached by running of my industry/trade or granting any electricity connection
to the same. The licensee is indemnified against any loss accrued by the applicant on this account that on an Order issued by a Court
of law or judicial authority or any government agency for disconnection of electricity, the licensee may disconnect the supply.

12. That I shall indemnify and hold harmless, the licensee, in case of any injury or incident on account of any fault in electrical work in
the premises, and the licensee shall not be liable for any mishap or incident occurring at the premises to the applicant on account of
any faulty/defective/inferior quality wiring at the premises for which the connection is being applied.

13. To pay the electricity consumption bills and all other charges at the rates set out in the licensee's Tariff Schedule and
miscellaneous charges for supply as may be in force from time to time, regularly as and when the same becomes due for payment.

14. To deposit the additional security deposit and additional service line cum development (SLD) charges, if any from time to time
based on the prevailing Orders/rules, directions and Regulations of the Commission.

15. To abide by the provisions of the Electricity Act, 2003, all applicable laws, conditions of Supply/Tariff Orders and any other Rules
or Regulations as may be notified by the Commission, as applicable from time to time.

16. That licensee shall be at liberty to adjust the electricity consumption charges due/outstanding along with any other charges
against the Consumer Security Deposit paid by the Applicant, in the event of termination of the agreement prior to expiry of the
contracted period or in case of any contractual default as per provisions of regulations/rules/orders/directions of the Commission.

17. That as per Delhi Electricity Regulatory Commission (Supply Code and Performance Standards) Regulations, 2017 or as
amended from time to time, I shall provide suitable and adequate land space for installation of the meter/electrical equipments
where the licensee may have ready access to the same.

18. To allow clear and un-encumbered access to the meters for the purpose of meter reading and its checking etc.

19. That the licensee may disconnect the electric supply under reference, in the event of any default, non-compliance of statutory
provisions and in the event of a legally binding directive by Statutory Authority (ies) to effect such an order. This shall be without
prejudice to any other rights of the licensee including that of getting its payment as on the date of dischangeRequestConnection.

20. All the above declaration given by the Applicant shall be construed to an Agreement between the licensee and the Applicant.

21. That the applicant is having the approval for safety and/or fire clearance for EV charging station wherever applicable from the
concerned department such as Petroleum and Explosives Safety Organization (PESO), Fire Department etc.

22. That I/the applicant do hereby confirm and undertake that in case of falling within the requirement as stated below:

(i) Total cumulative demand of all floors in the plot/ building for LT service connection exceeds 100 kW/ 108 kVA, or

(ii) total cumulative built up area of the premises in the plot/building exceeds 2000 sqm, or

(iii) plot of size above 600 sqm or above,

I/the applicant shall unconditionally and unequivocally provide the space along with right to access, without any charge & in
perpetuity, for installation of Distribution Transformer to BRPL to energize my connection along with supply to other outside
consumers and shall execute all other documents including Sub-station Space Agreement/ Affidavit as notified by BYPL time to
time.

Verified at New Delhi that the content of the above self-declaration are true and correct to the best of my knowledge of behalf.

Note: Please read and accept self declaration/undertaking and scroll down to last to activate check box

Signature
Signature of Applicant/Authorized Signatory or Thumb Impression