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MAHARASHTRA NATURAL GAS LTD.

(A joint venture of GAIL (India) Ltd. & BPCL)

NAME TRANSFER FORM FOR DOMESTIC PIPED NATURAL GAS CONNECTION

To be filled by the new occupier/user of the property stated herein below & hereby request MNGL to transfer the ownership of
PNG connection bearing BP No…………………………………. & Meter No…………………………………..
NAME OF CUSTOMER:
ADDRESS:

TELEPHONE NO: *MOBILE NO:


E-MAIL ID:
ADHAR CARD NO:
ADDRESS WHERE PNG IS INSTALLED: (IGNORE IF SAME AS ABOVE)

NAME OF THE PREVIOUS USER OF PNG CONNECTION:


REASON FOR TRANSFER OF PNG: (TICK MARK ANY ONE)
1. Purchase of Property 2. Inheritance of Property/Succession
3. Property acquired by way of court order/Auction/Transfer of Tenancy/Leave & License /Lease
4. Demise of Registered customer 5. If any other
DETAILS OF TRANSFER CHARGES:
Rs…250… Cheque No……………Cheque Date………….BankName……………………….

NO OBJECTION CERTIFICATE (NOC) FROM PREVIOUS GAS CONSUMER:


I/We ……………………………. presently residing at ……………………………………. State that B.P.
No.……………………presently stands in our name. We have No Objection in transferring the above
PNG Connection in name of ……………………………………………………………….

Signature of Present Owner/User ………………………….............. Date:


Name of Present Owner ………………………………….. Place:

DECLARATION: I/We declare that whatever is stated herein above is true & correct and no information has been
concealed. If any information provided is found to be incorrect, MNGL shall be entitled to disconnect PNG supply
without any notice. I/We accept and agree the terms & conditions as amended from time to time. I/We agree to settle
the unpaid connection related charges, gas consumption bills of the previous gas consumer.
Signature of the Applicant ……………………………..…….. Date:
Name of the Applicant …………………………………… Place:

Please Provide Ownership Proof Documents- Index II copy/Latest Electricity Bill/Corporation Tax Receipt & Cheque
on Rs.250 in favor of ‘Maharashtra Natural Gas Limited’ with this form

Customer Care Office- Maharashtra Natural Gas Ltd. Flat No.1,1st Floor, 33 A Vedvati Apartment,Vimalbai Jadhav
Road, opp. Groundwater Survey office & Behind Chinar Building, Shivajinagar,Pune-411005
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FOR OFFICE USE

Connection Status: Converted / Non-converted Payment Status: Full / Part

CHECKED BY: AUTHORIZED BY:

Remark: _________________________________________________________________________________________