Consumer Type:
Note : All red (*) marked fileds are required.
Personal Information
Name * Spouse Name
Father's Name * Mother's Name *
Date of birth* Gender *
National ID/Passport no. *  Photo
Organizational/Institutional Information
Organization Name * Proprietor Name*
Proprietor's National ID * Proprietor's Birthdate*

Mailing Address
House/Plot/DagNo* LANE/Road No
Section Block
District* Post Code
Thana* E-mail  
Telephone Mobile*  

Connection Address
House/Plot/DagNo* LANE/Road No
Section Block
District* Post Code
Thana* E-mail  
Telephone Mobile  
Area* Division

Description of Connection
Connection Type * Phase
Tariff Category *  
Demad Meter* Total Demad Load *
No. of Existing Meter Total Existing Load