To, Date:-

_______________________

_______________________

_______________________

1) Consumer’s name :- __________________________________ Tel.No.________

2) Address (Electric Supply/Correspondence)

Room No.________ Floor No._________ Bldg. name _______________

Bldg. No. ___________ Road ______________ Mumbai ______________

3) Bill no. ___________________ Meter No.________4) Nearest St. Ltg. Pole no.____

5) Type of complaint pertaining to electric supply

____________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

(Attach separate sheet, if required )

Yours faithfully,

Encl:- 1) Electric bill

2)

3)

4)

5)

(Signature)

(Consumer’s name in Block letters)

(P.T.O)

NOMINATION :- (If the Consumer wants to nominate his representative to appear and

made submissions on his behalf before the BEST Undertaking the following declaration should be submitted. )

I/We the above named Consumer hereby nominate Shri./Smt. ____________________

who is not an Advocate and whose address is ________________________________

_____________________________________________________________________

_____________ is my/our REPRESENTATIVE in the proceedings and confirm that any statement, acceptance or rejection made by him/her shall be binding on me/us. He/She has signed below in my presence.

ACCEPTED

(Signature of Representative) (Signature of Consumer)

&nb

10. DECLARATION

(a) I/ We , the consumer /s herein declare that: (i) the information furnished herein above is true and correct; and (ii) I/ We have not concealed or misrepresented any fact stated hereinabove and the documents submitted herewith.

(c) The subject matter of the present Grievance has never been submitted to the Forum by me/ or by any one of us or by any of the parties concerned with the subject matter to the best of my/ our knowledge.

(e) The subject matter of my / our Grievance has not been decided by any competent authority/court/arbitrator, and is not pending before any such authority / court / arbitrator .

Yours faithfully

(Signature)

(Consumer’s name in block letter)

ACCEPTED

(Signature of Representative)

(Signature of Consumer)

Date_____________

To

The Electricity Ombudsman

Details of the Grievance are as under:

1. NAME OF THE CONSUMER ____________________

2. FULL ADDRESS OF THE CONSUMER ____________________

PIN CODE _________________

PHONE NO.

FAX NO_________________

EMAIL ID_________________

4. NAME AND FULL AD DRE SS OF THE FORUM, PIN CODE, PHONE NO. /

5. PARTICULARS OF CONNECTION AND CONSUMER NO.

( Please state nature of connection)

_________________________________________________________

6. DATE OF SU BMI SSION OF GRIEVANCE BY THE CONSUMER TO THE

FORUM ________________________________________________________

(Please enclose three copies of the Grievance)

7. SUBJECT MATTER OF THE

REPRESENTATION____________________________

(If space is not sufficient please enclose separate sheet )

__________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

. Whether the consumer has received the final decision of the Forum ?

( If yes, please enclose ?? three copies ?? of the Forum ?? s order conveying its final decision )

10 NATURE OF RELIEF SOUGHT FROM THE ELECTRICITY OMBUDSMAN

__________________________________________________________

( Please enclose ?? three copies ?? of documentary proof, if any, in support of your claim )

11. NATURE AND EXTENT OF MONETARY LOSS, IF ANY, CLAIMED BY THE CONSUMER (IF ANY) BY WAY OF COMPENSATION

Rs_________________

( Please enclose documentary proof, if any, to show that such loss is actual loss caused as a direct consequence of alleged act, omission or commission of the Distribution Licensee )

12. LIST OF DOCUMENTS ENCLOSED

13 . DECLARATION

(a) I/ We , the consumer /s herein declare that:

(ii) I/ We have not concealed or misrepresented any fact stated in hereinabove and the documents submitted herewith.

(b) The subject matter of my / our representation has never been brought before the Office of the Electricity Ombudsman by me/ or by any one of us or by any of the parties concerned with the subject matter to the best of my/ our knowledge.

(c) The subject matter of my / our representation has not been settled through the Office of the Electricity Ombudsman in any previous proceedings.

(d) The subject matter of the present representation has not been decided by any competent authority/court/arbitrator, and is not pending before any such authority / court / arbitrator.

Yours faithfully

(Signature)

(Consumer's name in block letter )

I/We the above named consumer hereby nominate Shri/Smt………………………………………….. who is not an Advocate and whose

address is . . . . .. . . . .. . . . . . . . . . . . .

……………………………………………………………………as my/our

presence.

ACCEPTED

(Signature of Representative)

(Signature of Consumer)

The procedure of redressal of consumer grievance in the Consumer Grievance Redressal Forum is available at "Maharashtra Electricity Regulatory Commission (Consumer Grievance Redressal Forum & Ombudsman) Regulations, 2006" on the Maharashtra Electricity Regulatory Commission's website " www.mercindia.org.in ".

The website of National Consumer Help line is www.consumerhelpline.in/ The e-mail id of National Consumer Help line is nationalconsumer.helpline@gmail.com "

Internal Grievance Redressal Cells of BEST