UTTAR HARYANA BIJLI VITRAN NIGAM LIMITED APPLICATION
FORM FOR ELECTRICITY CONNECTION
(1) Office Details [To be filled by office or system generated based Area input ] :
Operation Sub-Division Application Number Date of Application
Model Town Yamunanagar Y43-126-40 06/01/2026
(2) Application For Extension of Load
(3) Category of Supply NDS
(4) Type of Supply: Permanent
(5) Applicant Particulars
(a) Type of Applicant Private Institution or establishment
(b) Name of the Applicant [person/firm/Company/trust] KHALSA SCHOOL
(c) Name & Designation of Authorized Signatory in case of Companies NA
(d) Name of Father/ Husband/Director/Partner/Trustee Sh. Balbir Singh
(e) Identity Proof of the Applicant Aadhaar Card
(f) Mobile No. 97******93
Premise Details where connection is required
Plot /House/Flat No. Shri Guru Nanak Khalsa Senior Sector/Colony/Street NA
Secondary School
Village/Town/City Yamunanagar Landmark/neighbor Opposite Sanjay Book
Depot
Pin 135001 Property ID
MobileNo 97******93 Email sh****@g****.com
Address Shri Guru Nanak Khalsa Senior Secondary School NA Yamunanagar near Opposite Sanjay
Book Depot 135001
(6) Applied Load Details:
Connected Load [KW] Contract Demand [KVA] Purpose of Supply
2.00-6.00 N.A.-0.00 School
(7) Details of Connection on the same premise/property/other connections in the name of Applicant
Account Holder Account Address Category Connected Load [KW] Contract Demand
Number [KVA]
KHALSA SCHOOL 7454380000 Shri Guru Nanak Non- 2.0 NA
Khalsa Senior Domestic
Secondary School NA (NDS)
Yamunanagar near
Opposite Sanjay Book
Depot 135001
(8) Option of Consumer to Supply Meter & Metering Equipment : No
(9) Declaration by Consumer : I/We hereby declare that
(a) The information provided in this application is true to my knowledge.
(b) I/We agree to abide by all the Rules & Regulations of the Nigam & HERC.
(c) I/We will deposit electricity dues and old dues if any , as per the applicable electricity tariff and other charges failing which
the supply of electricity will be liable to be disconnected.
(d) I/We will own the responsibility of security and safety of the meter, cut-out and the installation
(e) I/We am/are the owner(s) / legal occupier of the premises in which supply of electricity is hereby
requisitioned for which true copies of documents are submitted.
(f) That the internal wiring at the premises has been got executed and tested by a Licensed Electrical Contractor/ designated
officer of the Government and test certificate is available with the applicant.
Dated:- 06/01/2026
Place:-
