Pe, 7. Total connected/adsitional load applied for (Watts/H.P.KVA) '& Level of supply voltage (Low voltage/t1 KV:33 KV 10 KV) 8. Tho system of wiring will be : 10. The wiring work wil bo cartied out by Wiing Contractors Licence No. : Name : Aasross : ‘Yours faithfully, 200. (Aaplican’s signature & Name) 1). The applicant is requested to fil the blanks, strike out the clauses which are not applicable and attach relevant documents, 2) The Electricity Department shall not be bound fo comply with any such requisition under Section ‘43! of the Electricity Act, 2003 unless and until the applicant abides by the terms stated her ) Within fiteen days after service of a notice in wiring in this behall on him by the Electricity Department, tenders to the Electricity Department a written contract in the form approved by the Government of Goa, duly executed and binding himself to take the supply of energy for not ess than 2 years alongwith sufficient security of such an amount as determined by the Electricity Department on the basis of regulations in force and guarantee reasonable retum to the Government at current rates charged by the Electricity Department. 1) It required by the Electricity Department to do so, pays to the Electricity Department the cost of any serve line as may be laid down or placed for the purposes of the supply upon the property in respect of which the requisition is made, and of s0 much of any service line as it may be necessary for the said purposes to lay down or place beyond 30 meters from the Department's distributing mains, although not on that property ; and Ini of the contract referred to in Note 2(a) above, the Department is prepared to accept a declaration {nthe folowing form subjéct to deposit of any required security by the applicart:— . Declaration We hereby declare that We desire to have and agree withthe Electricity Department to take supply of energy for the purposes mentioned in the requisition for a period of not less than two years trom the date ‘of commencement of supply as determined by the Electricity Department and to be bound by the provisions. ‘of the Electricity Act, 2003 and to pay the Electricity Department's charges as per the appropriate tarits applicable to mefus trom time to time in fore. : (Aoolcant sindture& name) (Gon. Pig. Press, Panai-Goa — 459/10,000 — 82008