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Application # : Registered Date :
Legal Name of Company : Name of contact person :
Mobile Number : Land line number :
Email Id : Survey Field No :
Address for Correspondence : Site Address :
District : Taluk :
Village : Type of category :
Is this New Connection? : Upfront Charges :
Requirement of water in MLD (Million Litres per day) : Total Amount (Application Fee + GST Amount) :
Application Fee : GST Amount :
Work Type : Application Status :
Uploaded Documents By Company :
Uploaded Documents By EE :

Payment Details
Payment Type Total Amount Transaction Ref No Bank Ref No