form rahul

5/23/2015 Welcome to IGL

http://www.portal.igl.co.in/wps/PA_UCnectionPrintForm/common/UsrConnectionStatus.jsp?&Rf=2015383358 1/5

INDRAPRASTHA GAS LIMITED(Joint Venture of GAIL (India) Ltd., BPCL & Government of NCT of Delhi)IGL Bhawan, Plot No. 4,Community Center, Sector9, R.K. Puram, New Delhi110022

Reference No.: 2015383358Date of Registration: 09/05/2015

APPL ICAT ION FORM FOR REG ISTRAT ION & SUPPLY OF DOMEST IC P I PED NATURAL GAS CONNECT ION

(To be filled in Block/Capital Letters Only)I/We wish to register for domestic Piped Natural gas connection as per details mentioned below :

NAME: Mr./Ms/Mrs. : rakesh varma

Father's/Husband's Name : late.sh manoher lal varma

Address : House No. : house no 360 Street Name : SAINIK VIHAR,PITAMPURA

State : NEW DELHI Pincode : 110034

Landline (Office) : (Residence) :

Mobile No. : 9711000996 Email : [email protected]

Type of Ownership, Please tick () Owner Rented

If Rented, please submit NOC to be issued by the lawful owner of the property as specified below :PAYMENT DETAILS : (NonRefundable additional charges, if applicable to be paid on completion of the installation as per Clause No. 2of Customers' Rights & Obligations)

Pay Order/DD/Cheque No. Date :

Drawn on : favoring "INDRAPRASTHA GAS LIMITED"

Amount : towards Refundable Security Deposit as per the terms and conditions stated overleaf.

Date:

PAYMENT IN CASH IS

NOT ACCEPTED

Yours's Faithfully

(Signature of the Applicant)

NO OBJECTION CERTIFICATE (To be Filled by the lawful Owner)(Applicable only if the premise is rented)

This is to certify that I, Mr./Ms./Mrs. am the lawful owner of the abovementioned property.

I have no objection, if the tenant of the property as mentioned above, avails domestic PNG connection from Indraprastha Gas Limited

Name : Date :

Permanent Address of Owner :

Landline (Office) : (Residence) :

Mobile No. : Email :

Proof of Ownership (as enclosed) :

Signature :



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form rahul

Documents

ift date

appl icat ion form

houseno360 streetname

newdelhi pincode