FORM NO. A-1

        To
        The Maharashtra State Electricity Board,
        __________________________(Office)

          1. I/We here request you to supply electrical energy to
             the
             premises owned/occupied by me/us hereinafter described.
          2. I/We hereby agree to keep supply and pay for the side
             energy security as may be demand in accordance with the
             rates and conditions of supply of the board in force
             from time to time and further declare and agree to take
             supply of energy for the under mentioned purpose for
             my/our benefide use for a period of not less than two
             years from the date of commencement of supply.
          3. I/We also undertake to supply within three months from
             the date the board intimates that it is the ready to
             supply to our premises failing which I/We undertake to
             pay the board the minimum charges as may be applicable
          4. In the event of death of individual/desolutions of
             amulgamation of
             the company I/We hereby nominate
             Shri/Smt./Sau._________________________________________
             ________to receive or adjust the deposit outstanding
             in/our name.
          5. This requisition is for:-
             a) A new service, b) Re-connection, c) An alteration to
             may existing installation, d) A temporary service, e) A
             change of name Shri____________________________
          6. Description of premises
             House No. Land Survey No.

             Street

             District :- Town/Village

             Owner's Name :-

             Owner's Addtress :-

        Incandescent          Plugs Heater        Total
        Lamps        Fans     etc.         Motors demand

        No. Wattage No.Wattage No.  Wattage No. BHP.  KW/HP
            of each    of           of          of
                       each         each        each



          9.   My/Our requirements are as follows :-

             The wiring will be charged out by :-
             Name of the licensed wiring contractor :-
             His License No.
             His Address :-
             Date :-                             (Signature of
             applicant)
             Name of applicant:___________________________
             Occupation : _______________________________



             Address:_______________________________________
                          _______________________________________

             (Strike out items not applicable).
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