Applicant Type * Select Private/Personal Installation Other Department/Organization Please Select Applicant Type

Enter a valid PAN/TAN number Required

Electrical Installation For * Select Individual Person Firm/Company Please Select Work Type

Name of Owner/ Consumer * Please Enter Name

Address of Site(As Per Demand Notice of Utility/Electricity Bill) * Please Enter Address

State

District * Select Ambala Bhiwani Charkhi Dadri Faridabad Fatehabad Gurugram-I Gurugram-II Hisar Jhajjar Jind Kaithal Karnal Kurukshetra Mahendragarh Nuh Palwal Panchkula Panipat Rewari Rohtak Sirsa Sonipat Yamunanagar Please Select District

PinCode

Contact Number * Please Enter Contact No. Enter valid Phone number

Email * Please Enter Email Id Enter a Valid Email