Enter Consumer No or New Connection Application No. And press GO button

Consumer No : New Connection Appln No :

Consumer Details

Consumer Name : Address Line1 : Address Line2 : Address Line3 : Mobile No : Email ID : Pincode : District Name :

* Details of Grievance : * Nature of relief sought from the forum :

Is this Grievance represented by Consumer Representative ?

Applicant shall print,fill,sign,scan and upload above information in Schedule-A.
To print above information,please click on Print button.

Note: Forum will only consider the signed information,uploaded as per Schedule-A.

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* Duly signed Schedule A : Other Supporting Documents :

* Declaration

I/We consumer hereby declare that the information given herein is true and correct.

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Schedule - A

Application to Forum for Redressal of Grievance

Date :_______________

Consumer No :

New Connection Appln No :

Consumer Name :

Address:

Pincode :

Mobile No :

Email ID :

Particulars of connection :
(Please state nature of connection)

Name of Distribution Licensee :

Details of Grievance :
(If space is not sufficient, please enclose separate sheet)

Nature of relief sought from the forum :
(Please enclose any proof to support claim, if any)

List of documents enclosed :

Declaration :

(a) I/ We, the consumer/s herein declare that:

(i) the information furnished herein above is true and correct; and

(ii)I/ We have not concealed or misrepresented any fact stated hereinabove and the documents submitted herewith.

(b) The subject matter of the present Grievance has never been submitted to the Forum by me/ or by any one of us or by any of the parties concerned with the subject matter to the best of my/ our knowledge.

(d) The subject matter of my/ our Grievance has not been decided by any competent authority/court/arbitrator, and is not pending before any such authority/ court/ arbitrator.

Yours faithfully

(Signature)

(Consumer's name in block letters)

NOMINATION - (If the consumer wants to nominate his representative to appear and make submissions on his behalf before the Forum, the following declaration should be submitted.)

I/We the above named consumer hereby Nominate Shri/Smt. ,who is not an Advocate and whose address is as my/our REPRESENTATIVE in the proceedings and confirm that any statement, acceptance or rejection made by him/her shall be binding on me/us. He/She has signed below in my presence.

ACCEPTED

(Signature of Representative)

(Signature of Consumer)

Some Text Goes Here

Enter Consumer No or New Connection Application No. And press GO button

Consumer Details

Consumer Representative Details

Upload Grievance Documents

Schedule - A

Application to Forum for Redressal of Grievance

Maharashtra State Electricity Distribution Company Limited

Consumer Grievance Redressal Forum