Application For New Connection
File No
Application No.
Request Date
1. APPLICANT NAME [BLOCK LETTERS]
First Name
*
Middle Name
Last Name
2(a). CORRESPONDANCE ADDRESS
House No.
*
Street
*
Area
*
GHMC HNo.
Pincode
Section
Ward.
Block
Constituency
2(b). SERVICE PREMISES ADDRESS
House No.
*
Street
*
Area
*
GHMC HNo.
Pincode
Section
Ward
Block
Constituency
3. CONTACT DETAILS
TEL [Off.]
TEL [Res.]
Mobile No.
*
Email
4.CONNECTION PARTICULARS
(As per)
Sq. Mts.
Sq. Yards
(a)MCH Sanc. Plan
Please Enter MCH Sanc. Plan.
5. Application Type
*
Please Select Application Type.
--Select ApplType--
BPL
CharityInstitute
FeasibilityReceipt
FillingStation
General
HSC
PublicStandPost
ReligiousCharity
6. Connection Type
*
Please Select Connection Type.
--Select ConnType--
SewerageConnection
WaterAndSewerage
(b).Reg.SaleDeed
*
Please Enter Reg.SaleDeed.
7. Category
*
Please Select Category.
--Select Category--
INDIVIDUAL/DOMESTIC
NON REVENUE CONNECTIONS
BULK
MULTI STORIED BUILDING
(a)Watersize
(mm)
Please Select Watersize.
--Select Watersize--
15
20
25
8. Total PlinthArea
*
Please Enter Total PlinthArea.
9. No.of Flats/Units
Please Enter No.of Flats/Units.
(b)Sewersize
(mm)
Please Select Sewersize.
--Select Sewersize--
100
150
200
250
300
450
10. No. of Floors(Excluding stilt and parking)
Please Enter No. of Floors.
11. Owner Type
Please Select OwnerType.
Select Owner Type
Single Owner
Multiple Owner
12. Servant Quarter
Please Enter Servant Quarter.
Select Servant Quarter
Yes
No
*
Mandatory Fields