Cesc Ac Application Form – Fill Out and Use This PDF

Chowringhee Square,	(Please fill up from previous year’s bill)
Kolkata – 700001
	Application Form for Temporary Supply connection during Puja

Sub: Durga / Kali / Jagaddhatri Puja: Requisition for Temporary Supply

(Please tick the Puja you intend to apply for Supply Connection) Through: Officer (Inspector) In Charge …………………..

We have arranged ………………………………….Puja in 2014.The application is hereby submitted duly filled in with necessary details along with necessary

requirement(4 in no.) i.e. No Objection from Police Station, Consent from Fire Brigade, No objection of the land owner where Puja will be organized and Test Form.You are requested to process the same .We hereby undertake to abide by the safety rules and shall not violate any statutory provisions including those related to unauthorized use/pilferage of electricity.

Necessary details

(Please write in Block Letters)

1.Name of the Puja Committee:

(Please write the name which is written on Donation Receipt Book)

2.Address: ……………………………………………………………………………………………………………………………………………………………………

3.e-mail ID (if any) : ………………………………………………………………………………………………………………………………………………………

4. Please connect a temporary supply from ____ /_____ /2014 to ____ /____/2014 i.e. for.....days, for required load of ......…………. KW inside pandal and

............ KW outside pandal.

5.Landlord of the premises where the supply will be taken.

a)i) Name and Address:

………………………………………………………………………………………………………………………………………………………...

b)

ii) Consumer No. …………………………………..iii) Light Post No……….. …………..............................................iv) Load (KW)…………

c)i) Name and Address:

……………………………………………………………………………………………………………………………………………………….

d)

ii) Consumer No. …………………………………..iii) Light Post No……….. ……………………………………….iv) Load (KW)…………

e)i) Name and Address:

……………………………………………………………………………………………………………………………………………………….

f)

ii) Consumer No. …………………………………..iii) Light Post No……….. ……………………………………….iv) Load (KW)………...

I agree to provide temporary supply to……………………………………….. ……………………………………………….for Puja Purpose.

a)Landlord’s full signature ………………………………………………………………………………………………………………………..

b)Landlord’s full signature ….……………………………………………………………………………………………………………………..

c)Landlord’s full signature ..………………………………………………………………………………………………………………………..

6.Name & Address of representative of Licensed Electrical Contractor who is supervising electrical wiring

…………………………………………………………………………………………………………………………………………………………..

7.Name,Address & Telephone No. of President ,Secretary & Treasurer of the Executive Committee

A) President: ………………………………………………………………………………………………………………………………………….

B) Secretary: ………………………………………………………………………………………………………………………………………….

C) Treasurer: ………………………………………………………………………………………………………………………………………….

TEST FORM

Installation at the following address:

1.……………………………………………………………………………………………………………………………………………………………..

Total Connected Load: …………………………………………….. Voltage …………………………………………………………………………

2.……………………………………………………………………………………………………………………………………………………………..

Total Connected Load: …………………………………………….. Voltage …………………………………………………………………………

3.……………………………………………………………………………………………………………………………………………………………..

Total Connected Load: …………………………………………….. Voltage …………………………………………………………………………

The Licence and Permit details of Contractor, Supervisor & Workmen engaged on Electric Installation are given below:

Details of Supervisor	Details of Contractors
Name & Address of Supervisor	Name, Address and Telephone No. of Contractor

Details of workmen engaged on the work

No.	Name	Permit No.	Class of work for which the permit is	Valid up to
			valid

WARNING TO CONTRACTORS

BEFORE SUBMITTING THIS FORM PLEASE ENSURE

1.THAT THE MAIN SWITCHES ARE CONNECTED TO OUR METER LOOPS WHERE PROVIDED

2.INSTALLATION COMPILES WITH REGULATION 35 OF CENTRAL ELECTRICITY AUTHORITY (MEASURES RELATING TO SAFETY AND ELECTRIC SUPPLY) REGULATIONS 2010.

3.THE CONTRACTOR’S LICENSE NO. , SUPERVISOR’S CERTIFICATE NO. & WORKMEN’S PERMIT NO. ARE PROPERLY INSERTED.

Steps to be taken for maintaining Safety / Advices to the Puja Organisers

Please take authorized supply connection considering safety of you and your family.

All wiring installations must be done by Govt. Licensed Electrical Contractor.

Please use new wire / cable inside Pandal and use connector at the joints.

Keep the puja Pandal at a safe distance of at least 2.13 meter from overhead mains.

Keep the Distribution Pillar Box free and accessible.

Use correct size of cable as per load. Use 7/20 copper cable for Main Line.

Use 3/20 copper for other wiring.

Connect earth wire at the distribution boards.

Keep distribution boards at a safe distance from pandal and use circuit breaker with the Main Switch.

If more than one form is necessary for temporary supply for Puja then , consent of Police Station on any of the forms will be in order.