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CPDCL
PDCL Name Change Application Form

Name Changes Request Details:-

Paste here your
Service Connection Number*:: ___________
_____________________________________________
recent passport
Circle Name*:
Anathapur
Kurnool
Mahaboobnagar
Medak
Nalgonda size photograph
ERO Code*: ______________________________
___________________________________

Consumer Details:-
Consumer Details Actual Details Changed Details
Surname
Name
Father Name
Caste
Mobile Number

Service Type: ____________________________

___________________ Reason for Name Change: __________________________________________
Location of Premises:-
House No*: ______________Street*: _________________________
________________________________________________________________
_______________________
Circle*:
Anathapur
Kurnool
Mahaboobnagar
Medak
Nalgonda
Mandal *:____________________________
______ Village*: _______________________________
_ Pin Code: _________________
___
Section Name: _________________________________ Location Type*:
Type
Urban
Rural
Location Name*: ___________________________________________
____________________________________ Load Connected:: _____________________
_______
Dispatch No: _________________________________
_______________

Informant Details:-
Aadhar Number: ______________________________
______________________________Informant Name*: ________________________________
_________________________________
Relation*: _________________ Door No: _________________ Locality/Land Mark: ___________________________________
_________________
District*: _________________________
_________ Mandal
Mandal*: __________________________ Village/Ward*:: _______________________
_______
Pin Code: ___________________ Mobile **: _____________________________ Phone: ________________
_______________________
Email: ____________________________________________
________________________________________________ Delivery Type*:
Type
Manual
Security Deposit (Available) *:: __________
_______________________
Proof Document*:
Gift Deed
Sale Deed
Ownership Certificate
Indemnity Bond
ID Proof*:
Aadhar Card Copy
Driving Licen
License Copy
Electoral Copy
Pan Card copy
Ration card copy

Document List: - (NOTE: All Upload Documents are in PPDF Format Only)

Application Form*

ID Proof*

Caste Certificate (Mandatory if SC/ST) *

Owner Ship Certificate/Sale Deed/Gift Deed (Selected Proof Document) *

Municipality/Gram panchayat Permission Letter
Letter*

Indemnity Bond*

Transfer Transferee Document
Document*

Latest Bill and Receipt*
Applicant’s Signature