NEW SERVICE CONNECTION
 
ON-LINE REGISTRATION FORM
  Division Sub-Division  
  Section Type of Service  
  Date of Application    
 
Consumer Type
  Main Type Sub-Type  
 
Name of the the Applicant/Firm
 
Salutation
  First Name......................Middle Name Last Name Name Sufix  
 
            
 
Contact Person
  Mobile No.  
 
Social Group
  Gender  
 

Communication Address

  House No   Line No  
  Street/Area/Sahi/Sector   Village/Town/City  
  Distict   State Odisha, Pin :  
  Contact No (Home)   Contact No. (Office)  
  E-mail   Mobile No  
 
Installation Address ( Same as Communication Address)
  House No   Line No  
  Street/Area/Sahi/Sector   Village/Town/City  
  Distict   State Odisha, Pin :  
 
Other Details
  Appliance Details   Click here Category  
  Connected Load   KW Load Applied for  
  Phase   Supply Voltage volt  
  Nearest/Existing Consumer's No.   Document Details Click here  
 
Reference of any pending new service connection request (if any)
  Office Name   Prev.Req.Given On (dd/mm/yyyy)  
  Ref. No. (if any)