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Annexure 4A

(See clause 6.38)

Self Declaration of Connected Load


1. Name and address of the Consumer
2. Consumer No. / Account No. .
3. Category of Consumer
4. Purpose of Supply
5. Details of Load Connected.
Sl. No.

Name of Appliances

Unit

No.

Total kW/HP

(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)

Total Aggregate Load ..


Note: In case of HT/EHT/Railways the details of transformer installed and the Connected
Load to be furnished
6. Sanctioned Load
7. Extra Load ..

Date

Signature of the Consumer

(101)

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