Are you searching for an easy way to manage some of your customer's information? Look no further than our brand new Lpg Customer Form! This incredibly user-friendly form is designed to streamline the customer onboarding process, ensuring that all necessary data points are captured with accuracy and efficiency. Get ready to say goodbye to frustrating paperwork and welcome a reliable digital alternative that keeps customer info secure – let’s get started!
Question | Answer |
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Form Name | Lpg Customer Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | indane gas new connection documents, indane gas online registration for new connection, indane gas new connection form, indane gas connection online |
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* |
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Salutation (Mr./Ms./Mrs/Miss) |
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First Name* |
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Middle Name |
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Last Name* |
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(Name shall be entered as per Photo ID Proof) |
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Consumer Number |
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(only for existing customers) |
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Date of Birth* |
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D D M M Y Y |
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Father’s Name* |
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Mother’s Name |
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Name of Spouse |
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Address* |
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Address shall be written as per Proof of Address |
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House No * |
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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 |
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@ |
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*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
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
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 |
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Consumer Number (If allotted): |
Date: |
Signature of Distributor
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 |
(date) |
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Signature and Seal of Distributors |
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