MDBTL Version LO/i1-14 Sr. No. Form 2 LPG Linking Form (To be submitted to LPG Distributor) Step 1. Place your Original Aadhaar Letter* Step 2 . Take photocopy of this sheet & fill-up the here as shown below: following details in the photocopy in BOLD BLACK / BLUE inl y \ 1. NAME OF COMPANY (e.g. IOCL/BPCL/HPCL) 2. NAME OF DISTRIBUTOR 3. CONSUMER NUMBER (Attach a copy of first page of DGCC booklet or recent cash memo) }4, LPG ID (17 Digit No.) 5. NAME OF THE LPG CONSUMER &. YOUR REGISTERED MOBILE NUMBER or MOBILE NUMBER WHERE WE CAN CONTACT YOU PE 7. ADDRESS (Fill this only if your present LPG delivery address is different from address in the Aadhaar Card, please attach a current proof of address**) Place;_____ Date: jignature of the Consumer Enclosures: 1. First page of DGCC booklet or copy of recent cash memo, 2: Photocopy of proof of address if your address with LPG distributor differs from address in Aadhaar Letter, in case you have an e-Aadhaar, please fold it vertically and keep the left side (the side with your photo and Aadhaar Number as shown above) in the space provided above and follow the instructions as above **address Proof (Photocopy of any one of the following): * Aadhaar (UID) letter * Lease Agreement « Telephone or Electricity Bill or any other Utility Bill * Self-declaration attested by Gazetted Officer + Flat allotment or possession letter « LIC Policy * Driving License + Voter ID » Passport + Ration Card » House Registration Document, ACKNOWLEDGMENT SLIP: Received ‘Aadhaar LPG Linking Form’ from (Name), J Consumer No. alongwith copy of Aadhaar. Date: Sign & Stamp of Gas Distributor.