NDRAPRASTHA GAS LIMITED (Goint Venture of GAIL (India) Ltd, BPCL & Government of NCT of Delhi) GL Bhawan, Plt No 4,.Community Centre, Sector, RK Puram, New Deli-t10022 (To be filled in Block/Capital Letters Only) 1/We wish to register for domestic Piped Natural Gas connection as per details mentioned below :- NAME: Mr/Ms/Mrs, Father's Husband's Name [Address : House No, Sheet /Area/Sociery Site. Pincode Matile No Contact No. tao cat yest et, pawn) Owe] Renwi[] St Etnies ae abet tetris plas sabi NOC®(w bese ye vid oe fe ope) ‘Othe ale agent wile war be remis Proof of Residence (Anyone tobe Enclosed) ] Electricy Bit(Lates) —] Water Bit (ates) [Sete Deed 1 House tax Receipt (Latesy. [J] Altument Letter (From Govt Authority or Land Owning Agency) [_] Mutation Cette Customer LPG Connection Detals lindane Gascnian iy [E) Barat Gas (ahr Pele) Doyouhavean LPG conecton:{ ]Yes[No Yona tk) Gas Hindsan Perleum) [JOther Name of LPG Distributor: _ _ Consumer No, ‘Unique LPG ID (17 Digits) - PAYMENT DETAILS: Pay Order/DD/Cheque No. Date Drawn on favoring “INDRAPRASTHA GAS LIMITED” Amount; as per the plan/scheme opted. ‘Note: Non-Refundable daiional charges applicable o be pad on completion ofthe lastallaton a per Clause No.2 of Customers’ Rights & Obligations DECLARATION: hereby dectare that the detail furnished by meare true and correctto the best of my knowledge and belief hereby further declare that [have read and understood the Terms and Conditions (including undertaking wart. LPG Connection) mentioned overleaf and L accept the same in ts entirety, I acknowledge the receipt ofthe copy ofthe Termsand Conditions vide Customer Copy. “Pan Scheme Opt (Pes Sb amount Payable upfront] Et] Ba paity Charges POOL 15 Dept i SD of RD poe. (Stare of Re Apple {THN EM amin ches (noted) of Rs. 278 pee For FD Connon Sxuy Depot of 000. be pop * NO OBJECTION CERTIFICATE (NOC to be Filled by the lawful Owner) Applicable only if the premise is not owned) “hiss to ceri that, Me/Me Mes am the lnwful owner of the above-mentioned property [Ihave no objection, if the person eppying for PNG domestic connection as mentioned above, avails connection in hisher name fom IGL Permanent Address of Owner Contact No, / Mobile No Proof of Ownership (as enclosed)