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Customer Details: (In The Event of New Connection)
Customer Details: (In The Event of New Connection)
1. Customer Details
Applicant's Name Mr. PRABHUNATH KESHAVKUMAR AND ARJUN AND BROTHER GUPTA
(New Name in the event of Change
Of Name)
GSTN (As per Rule 114B of Income Tax Rules 1962) Refer point 19 from declaration cum
undertaking
(AS per Rule 49 of GST Rules,2017)Refer point 19 from
declaration cum underatking
Bank Name
Bank Branch.
Bank Account Number
Structure type
Lane/Street
Landmark
4. Types of premises
Number of meters (In case of building application) Single Phase:- 0 Three Phase :- 0
Name
Address
Telephone Number
E-mail
Licence No
8. Changeover of Supply
Meter Number The Meter will be provided by AEML Self
9. Documents Attached
A. Identity Proof submitted along with this application form :-
> if applicant is a person
>If applicant is an organization (mention Applicable)-Certificate of incorporation/registration issued by the Registrar
B. Proof of ownership or occupancy of premises for which electricity connection is required_____________________
I/We declare and undertake that I/we have complied with all statutory requirements under all Statutes for the time being in force.
I/we shall be solely responsible for any issue arising out of any such non-compliance and further I/we do hereby jointly and severally Indemnify
AEML, its agents and servants against all claims, proceedings, demands, costs, expenses and consequences whatsoever, which may arise on
account of processing my/our application.
Application processed by