APPLICATION FORMAT Applied for the post of _____ 1. Name of the applicant (In capital letters
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MAHARASTRA STATE ELECTRICITY DISTRIBUTION CO.LTD Date: To, …………………………….. M.S.E.D.C.L. ……………………. UNDERTAKING FOR CHANGE OF NAME (Simplified form to be used by Residential Consumers) Dear Madam / Sir Consumer No.:
Meter No.
Consumer’s Present Registered Name: Address at which supply is connected:
Pin Code I request you to transfer the above connection to my name. (Form A-1 enclosed). I am the tenant/occupant/owner of the premises. The connection is registered in the name of the previous tenant/ occupant/owner of the premises/in the name of the builders/ society. (Please fill if you don’t have a consent letter) I hereby declare that I am unable to get the consent letter from Mr./Mrs./s Who is/are the existing registered consumer for the transfer of the above connection from his/her/their name to my name. I am submitting the following documents in support of my ownership/occupancy of the premises. 1) 2) 3) I state that I am the sole occupant/owner of the above premises for which the abovementioned meter(s) are connected and the electric supply is used exclusively for the above premises. I also state that I am not receiving supply at the above premises through any other meters. In case of any false representation on my part or in case of any objection from the present registered consumer or in case the documents produced by me are not absolutely correct, the Company reserves the right to retransfer the connection in the name of the present registered consumer. I undertake to make the payment to the Company of all debits with respect to the present registered consumer that may arise at subsequent date. I also undertake to keep your Company indemnified of any consequences at any time in future in case of any dispute, on account of the transfer of the above connection to my/our/name/names. This undertaking will be binding on my self ourselves and my/our/her/executors and administrators. Yours faithfully Enclosed: Applicant’s Signature Name:
