FREE OF COST

TP NORTHEN ODISHA DISTRIBUTION LIMITED

(A Tata Power and Odisha Government Joint Venture)
Form No. 2
(See Regulations 3)

APPLICATION FORM
NEW CONNECTION/ LOAD ENHANCEMENT/ LOAD REDUCTION/ CHANGE OF NAME
(FOR OTHER THAN DOMESTIC AND GENERAL PURPOSE CATEGORY)
Affix photo of the
To
Sub-Divisional Engineer/Divisional Engineer Applicant
Name of the Division :-
Name of the Sub-Division :-

Dear Sir,

I, the undersigned on behalf of ……………………………………. request you to please submit an

estimate to me for provision of service connections & for supply of electrical power as per details given
below. The rate at which electrical energy is proposed to be supplied & other conditions of supply may
please be forwarded with your estimate.

I / We hereby request you for New connection/Alteration in Existing Connection/ Temporary Connection
to supply electrical energy at High Voltage/ Extra High Voltage for the premises owned / occupied by
me/ us.

11. Details of Applicant & Premises (where power supply is required):

a. Consumer Details:

Sl. No Particulars
1 Application For:
New connection  Change of 
Name/Transfer of
service connection
Load Enhancement  Load Reduction 
2 Name of the Applicant/
Organization:
(In Capital Letters)
3 Name of father/ husband/
Director/Partner/Trustee:
(In Capital Letters)
4 Consumer No.
(If application is not for New Connection)
5 Purpose of power supply (Tick mark only one of the appropriate option) :
Private residence  Cinema 
Factory  Workshop 
Industry,  Restaurant 
Irrigation,  Mill 

Pump  Allied agricultural 

activities

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: contactus@tpnodl.com, Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)
Domestic (Bulk)  Allied Agro Industrial 
Activities

6 Whether the premises is provided with

electrical power, if so, its nature and why this
additional power is required
7 a. If a factory, nature of manufacturing:
process & whether it is manufacturing
now or proposes to do so
b. Working hour/days of factory. :
c. Demand during the hours factory Will be
idle (K.W)
8 Category of Tariff/Supply:
9 Details of Contract Demand applied for (in
kW / kVA):
10 Power requirement in kW  New Connection  Change in
Contract Demand
a) Load factor ……….
Percent. a)Exiting CD:
b) Maximum demand b)Additional/Reducti
…….. K.W. on:
(c) M.D. expected c)Revised C.D:
during 5 p.m. to 10 p.m.
………………..
(d) Voltage of supply
required ...................at
3 phase 50 Cycles A.C
11 (a) Guaranteed monthly minimum
consumption, if any, per K.W. or per 100
K.W. or maximum demand/ connected load.
(b) Whether consumer accepts to pay for the
Minimum guaranteed consumption if the
Consumption falls short of the guaranteed.
12 Type of Supply (Tick mark only one of the option) :
Permanent  Temporary 
If Temporary supply, specify period of From Date:
requirement: (dd/mm/yyyy)
To Date
(dd/mm/yyyy)
13 Period for which energy is required.
14 Whether applicant accepts to execute an
agreement as per rules.
15 Period for which energy is required.
16 Legal status of applicant:
viz. Ownership/ partnership/
Private Ltd./ Public Ltd./
Society/ Govt Dept./ Govt.
Undertaking)
Registration No. and Date :
17 Name of Institution
developing Industrial
Premises:

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: contactus@tpnodl.com, Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)
18 Address Details of the premises for which new service connection is applied for / existing
connection is required to be shifted
Name of Applicant (In Capital Letters):
First Name:
Middle Name (If any):
Surname:

House/Flat No: Plot/Holding No. :

Village/Town/Street: Ward No:
Nearest Landmark:
District: Pin code:
19 Postal Address Details for Communication:
Name of Applicant
(In Capital Letters):
House/Flat No: Plot/Holding No. :
Village/Town/Street: Ward No:
Nearest Landmark:
District: Pin code:
Phone/Mobile No:
Email Id:
20 Possession Letter or No- Number:
Objection Certificate Date:

21 Status of land acquisition

22 Whether the requisite consent/ NOC (if applicable as per the list of Pollution Control Board) has
been obtained from .................... as per statutory requirements (If yes, attach a copy)

23 Any electricity dues outstanding in licensee’s area of operation in consumer’s name: Yes/ No
24 Any electricity dues outstanding for the premises for which connection applied for :Yes/ No
25 Any electricity dues outstanding with the licensee against any firm with which the consumer is
associated as an Owner, partner, Director or Managing Director: Yes/ No
(For questions 23,24 and 25
if the answer is ‘Yes’ in any
case, please provide details
on a separate sheet)

b. DETAILS OF LOAD REQUIRED:

(a) GENERAL
Item no. Nature of demand Number Connected load of Total Remark
(Light, fan, motor etc.) each point. Connected load

1. Light
2. Fans
3. Plug Points
4. Plug points
Appliances i.e., iron,
Cooker, Refrigerator.
5. Consignees.

Total:
TP NORTHERN ODISHA DISTRIBUTION LIMITED
(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: contactus@tpnodl.com, Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)

(b) MOTORS AND OTHER APPLIANCES.

Item no. H.P. of each Voltage Winding. Control Use Remark

K.W.

Total H.P. of all Motors : Total No. of Motors :

STEP-UP OR STEPDOWN TRANSFORMERS.

Item No. Capacity Primary Secondary
K.V.A Voltage Protection Voltage Winding Protector
Winding

Total:

I/ We hereby declare that:

(a) The information provided in this application is true to my knowledge.

(b) I/ We have read the OERC Distribution (Conditions of Supply) Code, 2019 and agree to abide
by the conditions mentioned therein.
(c) I/ We will deposit electricity dues, every month, as per the applicable electricity tariff and
other charges.
(d) I/ We will own the responsibility of security and safety of the meter, cut-out and the
installation thereafter.
(e) I/ We have no outstanding dues payable to the present distribution licensee or any other
distribution licensee within the state of Odisha incidental to the use of electricity.

Date: Signature of the consumer/ Authorised Signatory

Place: Name:

(In case of Firm/ Partnership/ Ltd. Company, Power of attorney Holder’s signature must be
supported by official seal)

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: contactus@tpnodl.com, Website: www.tpnodl.com
CIN: U40106OR2021SGC035951
FREE OF COST
TP NORTHEN ODISHA DISTRIBUTION LIMITED
(A Tata Power and Odisha Government Joint Venture)

Note: The following documents shall be attached with the application form:

1. Proof of ownership of the premises

2. A map indicating the proposed location of the plant/ office and the
point where supply isrequired. The map should also clearly show all
the boundary of the premises, the public road/s (with name/s of the
road/s) inside and outside of the premises/ land, roads, lands, roads
belonging to outside agency innerving the premises, if any.
3. License/ NOC from statutory authority, if required or a
declaration by the applicant that hisconnection does not fall under
the requirement of NOC under any statue.
4. In case of a proprietary firm, an affidavit to be submitted stating
that the applicant is the soleproprietor of the firm.
5. In case of partnership firm, partnership deed.
6. In case of Limited Company, Memorandum and Articles of
Association and Certificate ofIncorporation.
7. Proof of permanent residential address of the consumer and PAN
Number, if any. If there is anychange at a later date, the same shall
be intimated by the consumer to the licensee immediately.
8. Letter of intent for production/ enhancement in production may be furnished.
9. List of equipments proposed to be installed along with the expected load.
10. Resolution for authorized signatory.
11. Registration from Industries Department.
12. Extract of project report relevant to power and process requirements ( in case of
industries)
13. Copy of the relevant section of the current tariff order that provides
details of the tariff category opted by the consumer and duly signed
by him. This will be appended with the agreement after completion
of formalities.
14. Report of the Electrical Inspector/Licensed Contractor, as the case may be.

TP NORTHERN ODISHA DISTRIBUTION LIMITED

(A Tata Power & Odisha Government Joint Venture)
Registered & Corporate Office: Januganj, Remuna Golei, Balasore – 756 019, Odisha, India
Phone: +91 6782 244865, Email: contactus@tpnodl.com, Website: www.tpnodl.com
CIN: U40106OR2021SGC035951