Application For Second Connection
CAN
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
5. Application Type
*
--Select ApplType--
General
Slum
6. Connection Type
*
--Select ConnType--
WaterAndSewerage
(b).Reg.SaleDeed
*
7. Category
*
--Select Category--
INDIVIDUAL/DOMESTIC
(a)Watersize
(mm)
15
8. Total PlinthArea
*
9. No.of Flats/Units
(b)Sewersize
(mm)
--Select Sewersize--
100
150
200
250
300
450
10. No. of Floors(Excluding stilt and parking)
11. Owner Type
Select Owner Type
Single Owner
Multiple Owner
12. Servant Quarter
Select Servant Quarter
Yes
No
*
Mandatory Fields