C25

HIMACHAL PRADESH STATE ELECTRICITY BOARD

FORM-IV

FORM FOR LODGING COMPLAINT FOR DELAY IN ISSUE OF DEMAND NOTICE & RELEASE OF NEW CONNECTION/EXTENSION IN LOAD

To be filled in by Consumer Sub Division : ______

Complaint Ref. No.____

(To be given by HPSEB)

1. Name of the applicant and address of the premises for which power supply has been applied

2. Date of application for power supply along with documents submitted therewith

3. Load and purpose for which power supply is required

4. Reference of Demand Notice issued by HPSEB, where applicable

5. Receipt No. and date of depositing the charges as per Demand Notice, where applicable

6. Details of the complaint

7. Date of lodging the complaint

Signature of Applicant

Tear off (To be perforated) …………………………………………………………………………………………………………

ACKNOWLEDGEMENT TO BE FILLED IN BY HPSEB AND HANDED OVER TO THE APPLICANT.

1. Complaint Ref. No. Dated:

(to be given by the HPSEB)

2. Applicant’s name

3. Brief detail of complaint

4. Received on date

5. Complaint received by

6. Deficiency noticed in the application/

documents required from the consumer

7. Target date to resolve complaint

Signature of Authorized Officer

Designation:

SEAL

View Page Wise:

|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30|31|32|

|33|34|35|36|37|38|39|

( Any Page of the report can also be visited directly by typing www.hpseb.com/CX.htm in Address Bar, where XX is actual page number eg. www.hpseb.com/C1.htm )