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Eb Form

This document is an application form for agricultural service connection to supply power to agricultural pump sets. It requires details about the owner, the well, and the type of pump set, along with necessary certifications and signatures. Additional documents such as maps and ownership proofs must be enclosed with the application.

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sathiyavel
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70 views3 pages

Eb Form

This document is an application form for agricultural service connection to supply power to agricultural pump sets. It requires details about the owner, the well, and the type of pump set, along with necessary certifications and signatures. Additional documents such as maps and ownership proofs must be enclosed with the application.

Uploaded by

sathiyavel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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--1--

APPLICATION FORM FOR AGRICULTURE SERVICE CONNECTION

(Refer Clause 27 (2))

APPLICATION FOR SUPPLY OF POWER TO AGRICULTURAL PUMP SETS

(Note: The application should be signed by the owner of the well, if there are partners, all
must sign or consent to be given by co-owners)

To
The Designated Engineer,
(Address of the Licensee's Distribution Centre)

1. Name of owner of the well or partners ..


2. Full residential address of the owner ..
or partners

3. S.F. No. in which the well is situated ..


4. Revenue Village name, Taluk and District ..
5. Are and type of land to be irrigated by this
well (Wet/Dry) ..
6. Horse Power of motor pump sets proposed
to be installed ..

7. Type of pump set (Centrifugal/


Submersible/Air compressor) ..

8. Consent to abide by R&C of Licensee


with regard to duration of supply ..

It is certified, I am the sole owner of the well this application is signed by all partners

Place:
Date:
Signature of Applicant/Partners.
--2--

Note. The document such as FMB map showing the location of the well, patta, chitta, dangal
etc., shall be enclosed with the application

Date of receipt in the


Office of the Engineer

Certified that the open well/ bore well and lands measuring :……………………………acres and

…………….……..…………….in S.F. No……….….………………………..…..Village……….……………………………

…………………………………………………………of Taluk.

Exclusively owned by Thiru. …………………………………..………………………………………………………..

S/o………………………………………..…….……………….of….….…………………………………………………Village.

Jointly owned by

List of owners:

(1)………………………………………….…………..……S/o.…………………………………………………………

(2)…...………………………………….…………………..S/o……………….………………………………………..

(3)…….……………………………………………………...S/o…………………………………………………………

Certified that Thiru. ……………………………………….….….S/o……………………..………………………………….


Is small / big farmers (s).

VILLAGE ADMINISTRATIVE OFFICER.


V.A.O.

………………………………………………………………………………………….

…………………………………………………………………………………. / ………………………………………………………………………………..

………………………………………………………………………………………………………. .

……………………………………………………………………………………………………..

……………………................ …………………
…………………………. …………………………………..
.

………………………………………........................
………………………………….
.

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