Please wait...

Application Form

Application List

SL Name Category Load Phase Select
{{item.SL}} {{item.Name}} {{item.Category}} {{item.Load}} {{item.Phase}}

Personal Info

* marked fields are required
Applicant's Name required Name must be minimum 3 words Name must be maximum 100 words Name (in Bengali) required Name must be minimum 3 words Mother's Name required Name must be minimum 3 words Name must be maximum 100 words Father's Name required Name must be minimum 3 words Name must be maximum 100 words Mobile number is required invalide mobile number
Spouse Name required Name must be minimum 3 words Name must be maximum 100 words National ID required invalide National ID number Passport required invalide Passport number Male Female Please select Gender Date of Birth required

*** Maximum file size 150kb.

Signature

*** Maximum file size 150kb.

Photo
Chaptcha

Mailing Address

House/Plot/Dag No required Section required {{item.Name}} No District matching were found. {{item.Name}} No Thana matching were found.
LANE/Road No required Block required Post Code required Post Code should be 4 digit invalid E-mail invalid Telephone no

Connection Address

House/Plot/Dag No required Maximum 20 character LANE/Road No required Maximum 20 character Section No required Maximum 10 character Block No required Maximum 10 character Post Code required Post Code should be 4 digit {{item.Name}} No District matching were found. {{item.Name}} No Thana matching were found.
{{item.Name}} No Zone matching were found. {{item.Name}} No Division matching were found. {{item.Name}} No Area matching were found. invalide Email number invalide Telephone number Mobile number is required invalide mobile number

Description of Connection

Load Survey

Item Load per Item(Watt) No. of Items Total Load
None {{lItem.Name}} {{load.LoadValue}}
Total (Watt): {{TableTotalLoad}}

Description of Connection

Temporary Permanent Select Connection Type {{item.Name}} ({{item.Tariff}}) No Catagory matching were found. Organization/Shop Name required
Single Three Select Phase No. of Meter required Please servay Load 1st

Documents

{{msg}}