Application FormGujarat International Finance Tec-City Company Limited

Applied for Utility:

District Cooling System

WaterSewage

Solid Waste (AWCS);[JFGM 5|SFZ:

l0l:8=S8 S]l,U\ l;:8D5F6L;]V[hV[ 0A<I] ;L V[;

APPLICATION
FOR:VZÒGM 5|SFZ:

Permanent Connection
SFIDL HM0F6

Temporary Connection
C\UFDL HM0F6

Name Change
GFD AN,L

Type of Premises/ HuIFGM JU" s5|SFZf :Demand Extension
DF\UGM JWFZM

Demand Reduction
DF\UGM 38F0M

Removal of Services;[JF A\N SZJLFor Office Use / VMlO; SFD DF8[ oDomestic

Non-Domesticઘરે લ ુંબિન ઘરે લ ું

DateTFZLBOthers – Please Specify
VgI v lJUT :5Q8 H6FJM ______________________For Temporary Supply / C\UFDL HM0F6 CMI TM :Application No.
VZÒ G\AZ

TFH[TZGM 5F;5M8" ;F.h OM8MU|FO
Latest Passport size PhotoConsumer No.
U|FCS G\AZ

Date of connection _____________ to _____________;%,FIGL TFZLB
YL;]WLIn Case of Name change: Name of existing consumer
GFD AN,L DF8[ o CF,GF\ U|FCSG]\ GFD__________________________________________________________________________________________SAP No.
V[; V[ 5L G\AZ
Applicable Tariff,FU] 5+S

E-Bill confirmation / .vlA, 5]lQ8Sign Here / ;CL

Details of Applicant supported by necessary evidences are furnished hereunder / VZHNFZGL lJUTM H~ZL N:TFJ[H 5]ZFJF ;lCT VF ;FY[ ;FD[, K[oFull Name of Applicant
VZHNFZG]\ GFD____________________________________________________________________________________________________________________________Applicant Type / VZHNFZGM 5|SFZ
Public Ltd.
5la,S ,L.

Pvt. Ltd.
ºF.J[8 ,L.

Partnership
EFULNFZL

ProprietaryDFl,SLPAN No. :Occupancy Type:SAHFGM 5|SFZ

Govt. Dept.
;ZSFZL lJEFUReg. TrustZÒ:80" 8=:8Co-operative Society
SM. VM. ;M;FI8L

GST No. :
Owner
DFl,S

Joint Owner;C DFl,S

TenantEF0]VFT

Lease,LhOthers
VgIConnection Address details / ;%,FIGL HuIF V\U[ lJUTM :Unit / Flat No.:
V[SD q O,[8 G\P :Floor No.:
O,MZ G\P :Block No.:a,MS G\P :Road No.:ZM0 G\P :Building Name:lAl<0\U G]\ GFD :Zone:
hMG :DTA
0L8LV[SEZ
V[;.h[0GIFT City, Gandhinagar - 382355
lUO8 l;8L4 UF\WLGUZ v #(Z #55

E-mail:.vD[, :Mobile No.:
DMAF., G\P :Landline Tel. No.:,[g0,F.G 8[P G\P :Name and Designation of Authorized Person:
VlWS'T VlWSFZLG] GFD VG[ 5N :Total Build up Area / S], lJ:TFZ AGFJM : ______________ sq m / RM DL

Total number of Occupants / SAH[SZGFZGL S], ;\bIF :DCS Demand details / l0l:8=S8 S]l,U\ l;:8D DF\UGL lJUTM :Contract Demand / SZFZ DF\U : ____________________ TR / 8L VFZ

Ultimate Demand / V\lTD DF\U : ____________________ TR / 8L VFZ

Water / Sewage / AWCS Demand details / 5F6L / ;]V[h / V[ 0A<I] ;L V[; DF\UGL lJUTM :Total Water Demand / S], 5FGLGL DF\U : __________________ Liters/day / ºlT lNJ; l,8Z
Flushing / O,lX\U : _____________ Liters/dayDomestic / :YFlGS : ____________ Liters/day

Gujarat International Finance Tec-City Company Limited
EPS - Building no. 49A, Block 49, Zone 04, Gyan Marg, GIFT City, Gandhinagar – 382355

Gardening / AFUSFD : ___________ Liters/day

A) List of latest documents to be attached with new applicationi) Identity Proof (self-attested) (anyone)Electoral Identity Card
Passport
Ration Card
Driving License
PAN Card
Aadhar Cardii) Proof of ownership or occupancy for which utility connection isrequired (anyone)
Copy of registered sale deed or lease deed
Letter of Allotment
Ownership Certificate issued by GIFTUDA
NOC from Developer (For Temporary connection only)
Copy of Index (For Name Change)iii) If the applicant is a company, trust, educational institute,
government department etc. The application form shall besigned by a competent authority (e.g., Branch Manager,Principal, Executive Engineer, etc.) along with a relevant
resolution authority letter of the institution concerned.
iv) In case of Public and/or Private Limited Company – Theapplicant shall furnish the Memorandum and Articles ofAssociation and Certificate of Incorporation along with anauthorization in the name of the applicant for signing therequisition form and agreement.
v) In case of a partnership firm – The applicant shall furnish thepartnership deed and an authorization in the name of applicantfor signing the requisition form and agreement.
vi) Clearly marked area of utilization on approved plan of GIFTUDA,
jointly signed by building developer’s authorized representativeand Leaseholder’s authorized representative.
vii) List of Directors with address & contact details on company’sletter head (exempted for Government Institutions, PSUBanks).
viii) Copy of PAN and GST details of the applicant.
ix) Duly filled and signed installation test certificate is to besubmitted before the release of connection. The installation
test certificate is to be signed and sealed by the developer.
x) Buildup area certificate from GIFT UDA.
B) List of latest documents to be attached with application for
Name Changei) Submit the document mentioned at A i) & ii)ii) No Objection Certificate from the registered consumer orauthorized person of the premises shall be required for cases
involving transfer of security deposit in the name of applicant.
iii) No Objection Certificate by Co-Owner, in case of jointOwnership.
iv) Copy of latest bill duly paid.
v) In case the existing consumer is deceased, death certificate isrequired.
vi) In case of change of name to legal heir, any of the following
document shall be considered as acceptable proof of legal heir:
Registered Will/deedSuccession or legal heir certificate.
Mutation in municipal/land recordsvii) NOC from other legal heir(s) in case the connection is to bechanged in the name of one of the legal heirs.
viii) If the applicant is company, submit the documents mentioned
at A iii), iv), v), vii) & viii).
C) In case of application for contract demandalteration/conversion of service/change of consumer category,submit work completion certificate and installation test
certificate from developer (A ix)).

Gujarat International Finance Tec-City Company Limited
EPS - Building no. 49A, Block 49, Zone 04, Gyan Marg, GIFT City, Gandhinagar – 382355

D) Any Utility dues outstanding in GIFT City area of operation in
consumer’s name: Yes /No.
If ‘Yes’, provide Consumer No. ____________________________
lUO8 l;8L\ SFI"1F[+DF\ VZHNFZGF\ GFD[ VgI :Y/[ SM.56 AL, R]SJJFG]\ AFSL K[ o CF q
GF HM ‘CF’ CMI TM U|FCS G\AZ VF5M PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
E) Any Utility dues outstanding for the premises for whichconnection applied for: Yes/No.
If ‘Yes’, provide Consumer No. ____________________________
H[ 5lZ;ZDF\ SG[SXG DF8[ VZÒ SZL K[ T[ 5lZ;Z DF8[ SM.56 lA, R}SJJFG]\ AFSL K[ oCF q GF . HM ‘CF’ CMI TM U|FCS G\AZ VF5M PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPF) Declaration / HFC[ZGFD]
I / We hereby declare that.
a) The information provided in this application is true to myknowledge.
b) I/We desire and agree with the utility supplier to avail
connection for the above-mentioned purpose and of thedemand provided in this application form for the period notless than 2 yrs. From the first day of the month next to dateof commencement of connection by the supplier.
c) I/We have read the Supply Code issued by GIFT and agree toabide by the conditions mentioned therein.
d) I/We will deposit utility dues regularly as per the applicabletariff and any other charges.
e) I/We will own the responsibility of security and safety of themeter, its accessories, and the Installation thereafter.
C]\ q VD[ VFYL HFC[Z SZLV[ KLV[ S[V[f VF VZÒDF\ VF5[,L DFlCTL DFZL HF6SFZL D]HA ;FRL K[PALf C]\qVD[ lUO8 l;8L\ ;FY[ .rKF VG[ ;\DlT WZFJLV[ KLV[ S[ p5ZMST lGlN"Q8 C[T]DF8[ H HM0F6 X~ SZJFDF\ VFJ[ V[ TFZLB 5KLGF DlCGFGF 5|YD lNJ;YL A[ JQF"YLVMKF GCL\ V[JF ;DIUF/F DF8[ VF VZÒ OMD"DF\ NXF"J[, DF\U 5|DF6[ CMIP;Lf C]\ q VD[ lUO8 l;8LGM ;%,F. SM0 JF\R[, K[ VG[ T[DF\ p<,[lBT XZTM ;FY[ AFwIYJF ;\DT K]\qKLV[P0Lf C]\ q VD[ lA,GF AFSL GF6F\ lGIlDT ZLT[ ,FU] NZ VG[ VgI RFlH"; 5|DF6[ HDF
SZFJLX q SZFJLX]\P.f C]\ q VD[ DL8Z4 V[GF V[;[;ZLh VG[ .g:8M,[XG 5KLGL ;]Z1FF VG[ TS[NFZLGLHJFANFZL ,.X q ,.X]\P…………………………………………………………………………………………………
(Signature of the consumer or Authorized Signatory withCompany Seal)(U|FCS VYJF VlWS'T VlWSFZLGL ;CL VG[ ;LSSM)
Witness Name / ;F1FLG]\ GFD
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPP(Building Developer Authorized Person / lAl<0\UGF lJSF;STF" VlWS'T
VlWSFZLf

Witness Signature /;F1FLGL\ ;CL
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP(Building Developer Authorized Person / lAl<0\UGF lJSF;STF" VlWS'T
VlWSFZL\f*In case of thumb impression, name & signature of witness isnecessary. In case the applicant is a Firm / Partnership / Ltd.
Company, Power of attorney holder’s signature must be supported
by official seal.