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Note : All red (*) marked fileds are required.
Personal Information
 
Name * Proprietor Name
Father's Name * Mother's Name *
Spouse Name Gender *
National ID/Passport no. *  Photo
Date of birth   Maximum image size 150 KB 

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

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

Description of Connection
Connection Type * Phase
Category *  
No. of Meter * Total Demad Load *
No. of Existing Meter Total Existing Load
Meter owners are different person

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