Electricity form for Widow or Eligible Minor
Application form for concession of Free Electricity Supply Facility for Widow or Eligible Minor
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Name of Deceased Employee:
Name of Widow / Pensioner/Applicant:
Relationship of Applicant with Deceased Employee:
N.I.C of  Widow/ Applicant /Pensioner (With out Dash) *
Designation  of Deceased Employee:
BPS :
Date of Joining
MM
/
DD
/
YYYY
Date of Retirement / Death (Provide Copy)
MM
/
DD
/
YYYY
Contact No of Applicant/Pensioner:
Last Retiring Office (Of Employee):
Clear selection
Address of House where Free Electricity Facility Required :
Electricity Meter Reference No. *
Name Against Whom Meter is installed:
Status of Dues (if any):
Name of Concerned Revenue Office:
Name of Concerned Operation Sub Division:
Deceased / Gratuity /PPO/ GFP Account No. *
Entitlement of Free Units per month: *
Effective Date from which concession is allowed: *
MM
/
DD
/
YYYY
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