Lpg Customer Form PDF Details

In the intricate landscape of accessing Liquefied Petroleum Gas (LPG) connections, the LPG Customer Form plays a pivotal role, serving as the initial step for consumers aiming to register or update their details with their LPG distributor. The form mandates personal information starting with the distributor name, which consumers must fill accurately to ensure smooth processing. Aside from basic identification details such as name, date of birth, and address, which need to be consistent with official documents, the form extends its requirements to include details of existing customers through the consumer number. Furthermore, it prompts the submission of a photograph, reinforcing identity verification. In an effort to cater to comprehensive background checks and facilitate communication, it asks for multiple contact points including telephone numbers and an email ID. Notably, the form demands at least one proof of address from a specified list, ensuring legitimacy and current residency of the applicant. Additionally, it inquires about other governmental identifications, potentially linking the consumer's LPG account with broader civic and financial databases for verification and subsidy purposes. The form concludes with a declaration from the consumer, emphasizing the accuracy of the information provided and acknowledging the potential consequences of any discrepancies. This rigorous compilation of consumer data underscores the commitment to safety, regulation compliance, and the efficient distribution of LPG, which remains a crucial energy source for millions. Finally, a portion for distributor verification binds the document, completing the registration or update process.

QuestionAnswer
Form NameLpg Customer Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesindane gas new connection documents, indane gas online registration for new connection, indane gas new connection form, indane gas connection online

Form Preview Example

Distributor Name:

(To be filled by consumer while registering for LPG Gas connection)

Particulars

Please write correct details as given in documents

Name of Consumer*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salutation (Mr./Ms./Mrs/Miss)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Name shall be entered as per Photo ID Proof)

Consumer Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(only for existing customers)

Date of Birth*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D D M M Y Y

Father’s Name*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mother’s Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Spouse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address shall be written as per Proof of Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

House No *

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Paste your photo

here

House Name/Flat Floor No *

Housing Complex/Building

No. *

Street/Road Name *

Area/Land Mark

City/Town/Village *

District *

State *

PIN Code *

Telephone Number

Mobile Number

Email ID

 

@

 

 

 

 

*Mandatory Fields

CONSUMER INFORMATION SHEET (Page 2)

At Least one of the following documents of Proof of Address is Mandatory. Kindly tick the document provided for Proof of Address

Aadhaar (UID)

Lease agreement / rent receipt Telephone/Electricity or any other utility bill Self-declaration attested by Gazetted officer. Flat allotment/possession letter

LIC Policy

Driving License No

Voter ID No

Passport Ration Card

House registration document

Do you have Pan Number: Yes/No

If Yes, Please enter PAN Number

Do you have a Passport: Yes/No

If Yes, Please enter Passport Number

Do you have a Driving License: Yes/No

If Yes, Please enter Driving License No

Do you have a Ration Card : Yes/No

If Yes, Please enter Ration Card No

Do you have UIDAI Adhaar No: Yes/No

If Yes, Please enter your Adhaar No

Do you have Voter ID (EPIC-Election Photo ID Card): Yes/No

If Yes, Please enter your Voter ID No

Do you have Id Issued By Central State Government): Yes/No

If Yes, Please enter your ID No

Optional Details

Bank Name

Physically

Verified by Distributor?

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Branch & Address

IFSC Code

Account Number

Declaration: I declare that the information provided by me on the above form is true and correct to the best of my knowledge and belief. I also confirm that in the event of any information provided by me is not true and incomplete and also in the event of any violation of Government Regulation related to the supply and distribution of LPG, IOCL will be well within its right to take necessary action including discontinuation of supply of LPG cylinders, can forfeit the security deposit and can levy panel charges as per the policy and guidelines. I am willing/not willing to avail the Subsidy on LPG cylinders therefore I have provided/not provided my Bank account details on the above request form

Name & Signature of Customer *

Date:

To be filled by Dealer/Distributor

 

Consumer Number (If allotted):

Date:

Signature of Distributor

------------------------------------------------------------------Tear Off----------------------------------------------------------------------

I/We, hereby, confirm receipt of duly filled in KYC form along with relevant documents of Proof of Identity and Proof of Address has

been received from -----------------------------------------

on----------------

(date)

Signature and Seal of Distributors

 

 

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