Load Approval | Application

Note : All red (*) marked fields are required.

Customer Information

Name*

Spouse Name

Father's Name*

Mother's Name*

Date of Birth*

Gender*

National ID/Passport*

Photo

(Max photo size is 1 MB)

Mailing Address

Address Line 1*

Address Line 2

Address Line 3

E-mail

District*

Thana*

Telephone

Mobile*

Connection Address

If the Mailing address and Connection address are same, please tick the box

Address Line 1*

Address Line 2

Address Line 3

E-mail

District*

Thana*

Telephone

Mobile*

Division

Area*

Description of Connection

Connection Type

Phase

Tariff Category*

Current Load(KW)*

Load Item Details

	Load Item	Quantity	Unit Load (Ton)	Total Load (Ton)