MAHA 'U" FORM FOR CHANGE OF NAME Date of Application: To, The Ottice In Charge, Sui Division! Circte Office Dear Sir/ Madam, | nereby submit this application for Change of Name of connection as mentioned below. 2) Details of Ole Consumer | Reports Name Fast ome Teo Faeroe es tock erters 5 ae Conayvah ud 2 [Comune No: Mooi wed 2) Details of New Consumer TT [rear Nome Frairame Tome o Father Reson Saare en svock erreRs | 2 Ema Prone No Mobi No) 3) aahar Card No.(Optional 3) Reason for Change of Name 4) Document enclosed (Please secity) (Pleace see Annexure") Note: _LFor transer of Security Deposit, old consumer should give consent, in absence of such consent incoming consumer ‘wil pay security deposit. 2.1 old consumer wants refund of Secrity Deposit then fil up form "x", 3 Incase of arrears this application will not be processed! andintimation willbe sent to new consumes Declaration: These declare tat al abide by the provisions of Electricity Act 2003 and Maharashtra Electricity Regulatory Commision (Bectrcty Suppiy Cove ane tres eonaitions of Suppiy) Regulation 2005 wl further abide by rules & regulations sve by regulatory bodes & MSEDCL from tone tte. wil pay the elecrcy bill as per prevaing MSEDCL Tani. the premises ectared unauthorized thes ot the inet cation by competent guthonity, MSEDCL wil have iberty Lo remove the electric cannestion mmecdatey Teenave information is te and ¢ any false information is observed, 1/ we wil be resjomsite for the consequence Note: You can upload signed copy ofthis fon 6 relevant sacament for change of mane, on BASEDCL website OR by using Sinature of Applicant Applicant Name eotatie MSEC Appliation ReceivedAnnexure “A” Hocume equired (pease tel: [aay one of . Occupa by statmtory body 7 Com sent Authority b, Ownership Documentiform 8 / Form 7-12/ 1 ease issued hy Local Authority c. Cenified copy of Comes Gif Deed) 4. Certificate of Incorporation issued as per provision of companies Act 1956. &. Affidavit Gazette Notification for himself (Incase applicant himself has changed his name) Legal document supporting letting and NOC of the owner. (a case f premises is let put 19 the applicant) ‘ponding Leva Document (In case oF inheritance f succession / will FORM “x” 8) Transfer of Security Deposit 1, Shri Smt. Mis, for transfer of Security Deposit held against my consumer no. in the name of transferee Shri / Smt/ (Ms Signature of Old Cousumer OR b) Refund of Security Deposit I Sb Gre, fe, ese Ee percby pie comet totransfer the connection in the name of transferee Shri J Smt, /MIs Name of Account Holder: + Name of Bank & Branch: Bank A/eno.: FSC no. Original Receipt no.: Siguature of Old Consumer 1 request to refund the security deposit held against my consumer no. to me. For refund of security deposit Original Receipt is enclosed, OR my (Original Receipt of S.D. is lost, lam enclosing indemnity bond. ‘The Account details for ECS ate as below. ii1 We hereby give consent to transfer MSEDCLtd, Electricity bill Of consumer NO. in the name of Shri jsmvSav__ [MWS - Paloiya hai hh, ‘The said premises address is mentioned ee - YWe have no objection to transfer the electricity bill in above mentioned name. If any legal or any type of discrepancy occurred regarding this premises ownership; Maharashtra State Electricity Distribution Company Limited Side is safe, We are totally responsible for any type of discrepancy. 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