FEDERAL ELECTRICITY COMMISSION APPLICATION No.

REQUEST FOR ELECTRIC POWER SERVICE (RECEIVING AREA)

UNDER THE CONTRIBUTION REGIME DATE
DIA MES YEAR

I HEREBY REQUEST A TECHNICAL-ECONOMIC STUDY TO BE CARRIED OUT FOR:

( ) to obtain electric power service ( ) modification of supplier's facilities
AT THE ADDRESS AND WITH THE DATA TO BE INDICATED.
APPLICANT'S DETAILS
NAME, COMPANY NAME OR CORPORATE NAME
ADDRESS OF THE REQUESTED SERVICE COLONY
BETWEEN STREETS DELEG. O MPIO. C. P.
STATUS TEL. FAX.
CELL NUMBER E-MAIL
COMPLEMENTARY REFERENCES FOR SERVICE LOCATION

ADDRESS TO RECEIVE NOTIFICATIONS COLONY

DELEG. O MPIO. STATUS TEL. FAX.

CHARACTERISTICS OF THE REQUESTED SERVICE

TYPE * TENSION PHASES CLASS OF SERVICE
( ) NEW ( ) LOW ( ) 1 ( ) DOMESTIC ( ) STREET LIGHTING
( ) LOAD MODIFICATION ( ) MEDIA ( ) 2 ( ) COMMERCIAL ( ) COMMERCIAL CENTER
( ) PROVISIONAL ( ) ALTA ( ) 3 ( ) INDUSTRIAL ( ) FRACC. O U. HAB.
MONTHS
( ) COL. O VILLAGE ( ) SCHOOL

No. OF THE REQUEST FOR No. OF SERVICES ___________ ( ) WATER PUMPING ( ) EDIF. OFNAS. O DEPTOS.
DEFINITIVE SERVICE DATE REQUIRED ( ) MARKET ( ) TOURIST DEVELOPMENTS
THE SERVICE _______________ ( ) INDUSTRIAL PARK ( ) OTHER
SPECIFY
* FOR LOW VOLTAGE AND, IF KNOWN, INDICATE THE DISTANCE BETWEEN THE NEAREST POLE OR REGISTER OF THE SUPPLIER AND THE INSTALLATIONS.
OF THE APPLICANT METERS

SERVICE LOAD AND DEMAND DATA

NEW OR TEMPORARY SERVICE: LOAD TO BE CONTRACTED ____________ KW REQUESTED APPLICATION KW
SERVICE WITH LOAD MODIFICATION:

CURRENT TO BE CONTRACTED
CONTRACTED LOAD KW
CONTRACTED DEMAND KW UPLOAD KW
No. OF PHASES DEMAND KW

ADDITIONAL DATA FOR MEDIUM AND HIGH VOLTAGE SERVICES

PRIVATE SUBSTATION CAPACITY KVA PRIMARY VOLTAGE * KV SECONDARY STRESS
LOCATION OF THE S. E. PROPOSED BY THE APPLICANT ( ) GROUND FLOOR ( )1st. ( )OTHER
SPECIFY
BASEMENT

USE OF THE SUBSTATION ( ) INDIVIDUAL ( ) SHARED ( ) PEDESTAL ( ) OTHER

TYPE OF SUBSTATION: ( ) ENCAPSULATED ( ) ( ) BLINDED ( ) INTEMPERIUM ( ) POST
MODIFICATION OF FACILITIES
( ) POSTS ( ) ACCOMPETITION(S) ) SUPPLIER'S SUBSTATION
( ) LINES ( ) MEASURING EQUIPMENT (( ) OTHER
SPECIFY
I DECLARE UNDER OATH THAT THE ABOVE INFORMATION IS TRUE:
IN THE CASE OF A LEGAL ENTITY IN CASE OF A DESIGNATED PERSON
NAME: TO CARRY OUT THE PROCEDURES
POSITION:
APPLICANT'S SIGNATURE NAME AND SIGNATURE

SIGNATURE: TEL: —
REMARKS:
 EQUIREMENTS TO OBTAIN THE SERVICE

2 THE APPLICANT SHALL SUBMIT THE ADDITIONAL

DOCUMENTATION AND INFORMATION
NECESSARY FOR THE PREPARATION OF THE
CORRESPONDING PROJECT AND BUDGET, ONCE
THE SUPPLIER NOTIFIES THE APPLICANT THAT
THERE IS NO TECHNICAL IMPEDIMENT.
T RAMIT AR THE PRESENT REQUEST.
THE RESPONSE TIMES OF THE SUPPLIER, AS
PROVIDED IN ARTICLE 34 OF THE REGULATION OF THE LAW OF THE PUBLIC ELECTRIC ENERGY SERVICE, IN THE
MATTER OF CONTRIBUTIONS, WILL BE IN WORKING DAYS AND WILL BEGIN ON THE DAY FOLLOWING THE DATE ON
WHICH THE SUPPLIER ACKNOWLEDGES RECEIPT OF THE REQUESTED DOCUMENTATION AND INFORMATION.

3 FOR HIGH VOLTAGE SERVICES, FROM THE MOMENT THIS REQUEST IS RECEIVED, AN ADEQUATE COORDINATION WILL
BE ESTABLISHED BETWEEN THE REQUESTING PARTY AND THE SUPPLIER, IN ORDER TO SPECIFY THE NECESSARY
INFORMATION REQUIREMENTS.

4 IF APPLICABLE, TO COVER THE CONTRIBUTION TO BE PAID BY HIM.

5 WHEN REQUIRED, COMPLETION OF THE SPECIFIC WORK AND/OR MODIFICATION OF THE FACILITIES.

6 WHEN THE CASE SO WARRANTS, DELIVER TO THE SUPPLIER THE ORIGINAL OF THE CERTIFICATE ISSUED BY THE
VERIFYING UNIT.

7 TO ENTER INTO THE CORRESPONDING SUPPLY CONTRACT.

GENERAL RECOMMENDATIONS

1 ATTACH A LIST OF LOADS THAT COVERS THE LOAD TO BE CONTRACTED, CONSIDERING THE CAPACITY EXPRESSED IN
WAT T OF: MOTORS, LAMPS, COUNTERS AND SPECIAL LOADS SUCH AS: WELDING MACHINES, OVENS AND X-RAY
MACHINES, AMONG OTHERS.

2 TO FACILITATE THE LOCATION OF THE PLACE WHERE THE SERVICE IS REQUESTED, A LOCATION SKETCH MUST BE
ATTACHED TO THIS APPLICATION.

3 IN THE CASE OF MEDIUM AND HIGH VOLTAGE SERVICES, THE SUPPLIER SHALL PROVIDE THE SHORT-CIRCUIT LEVEL
AT THE SUPPLY POINT AND, IN DUE COURSE, THE APPLICANT SHALL PROVIDE THE MAKE, TYPE AND INTERRUPTING
CAPACITY OF THE PROTECTION AND DISCONNECTION MEANS TO BE INSTALLED IN THE SUBSTATION.
-THE COMPANY'S OWN EQUIPMENT, IN ORDER TO ENSURE THE CORRECT COORDINATION OF PROTECTIONS
BETWEEN ITS OWN EQUIPMENT AND THAT OF THE SUPPLIER.

4.- IF APPLICABLE, TO HAVE THE AUTHORIZATIONS AND PERMITS ISSUED BY THE COMPETENT AUTHORITIES, SUCH AS:
CONSTRUCTION LICENSES, LOTTERY PLANS, AGREEMENTS PUBLISHED IN THE OFFICIAL GAZETTE OF THE FEDERAL
ENTITIES, FOR THE AUTHORIZATION OF RESIDENTIAL SUBDIVISIONS AND INDUSTRIAL PARKS, AMONG OTHERS.

THE SUPPLIER