NEW GAS CONNECTION KYC BPL CARD

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DECLARATION

I , Mewa Lal S/O Sh. Shyam Lal R/O H.No. 284, L-Block, J.J.Colony, Bawana, Delhi-110039 ( Complete address at which LPG Connection is required) desire to take domestic LPG Connection in my name and affirm as under:

1. That I am the Citizen of India.
2. That my date of Birth/Age is 13/05/1976 ( LPG connection cannot be provided to a person under 18 years of age). 3. That neither I nor any other member of the household( Household means a family consisting of husband, wife, unmarried children and dependent parents living together in a dwelling unit having common kitchen) , possess any LPG connection from PSU Oil Companies or Piped Natural Gas connection, for domestic use. 4. @ That I am enclosing a copy of Ration Card Number BPL22640314 including my Mother’s name. Or

@ That I do not have any Ration Card in my name or in the name of any member of my family as defined above. @ Delete, whichever is not applicable.
5. That I am enclosing the following documents. a) _______________________ as a proof residence.
b) NEJ0610089 as a proof of identity. 6. That I confirm that the LPG/PNG connection issued to me will be used in my above mentioned address and for domestic cooking purpose only and I shall abide by all terms governing its use. 7. That I shall not possess any other L.P. Gas installations in the same kitchen.. 8. That as and when second cylinder is issued to me against this connection, the same will also be used in the same kitchen and with the original installation. 9. That whenever I change my residence from present address to another, I will inform the M/S BAWANA GAS SERVICE Name of Distributors /RGGLV) in writing in advance for change of address in the records. 10. That I am...