Apply for Additional Connection
Date of Application : 04/08/2015
Applicant Particulars
PT Assessment Number
Name of Applicant
Mobile
Email
Locality
Address
Zone / Ward / Block
Property Tax
Aadhaar No
Connection Details
Connection Type
Select from below
Metered
Non-metered
Usage Type
Select from below
Commercial
Domestic
Drinking
Industrial
Non-residential
Residential
Category
Select from below
BPL
Commercial
Domestic
General
OYT
Water Source Type
Select from below
Ground Water
Surface Water
Property Type
Select from below
Ground Floor
One store building
Two store building
H.S.C Pipe Size (Inches)
Select from below
Zero Inch
1/2 Inch
3/4 Inch
1 Inch
Sump Capacity (Litres)
No. of Persons
BPL Card Holder Name
Assistant Engineer Inputs
S.no
Material
Quantity
Unit of Measurement
Rate
Amount
Actions
1
2
Grand Total
Category Of Road
Select from below
Municipal Road
CC Road
BT Road
R&B Road
Existing Distribution Pipeline
Pipeline to Home Distance
Digging Charges
Supervision Charges
Material Charges
Estimation Charges
Enclosed Documents - Check List
Document Name
Document Number (
)
Document Date (
)
Attach Document(
)
Ration card
BPL Card
Approval Details
Approver Department
Select from below
Accounts
Bridges
Buildings
Education
Electrical
Family Welfare
General
Health
Land and Estate
Legal Cell
Mechanical
Parks and Playfields
Revenue
Roads
Solid Waste Management
Storm Water Drains
Town Planning
Works
Zone 1
Zone 10
Zone 2
Zone 3
Zone 4
Zone 5
Zone 6
Zone 7
Zone 8
Zone 9
Approver Designation
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Approver
Select from below
Comments
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