Meeseva Civil Supplies New Gas Connection Application Form

Meeseva Civil Supplies New Gas Connection Application Form

Download Meeseva Civil Supplies New Gas Connection Application Form

New Gas Connection
LPG Distributor Details: (Please select the customer resident district and location to locate the GAS distributor)
LPG Gas Type*:
Location*:
Distributor Address:
Distributor Pin code*:
Distributor Email Id:
Applicant Details (Residential Address)
Applicant Name*:
Profession*:
No of Family Members*:
Whether used LPG earlier*:
Landmark/Locality/Colony*:
Mandal*:
Pin code*:
Residence Phone No*:
Informant Details
Informant Name*:
Mobile No*:
Proof Document*:
Documents List
(NOTE: 1.All Upload Documents should be in PDF Format
1.Application Form*
2.Proof Document*
New Gas Connection Application Form

LPG Distributor Details: (Please select the customer resident district and location to
District*:
LPG Distributor Company*:
Distributor Contact No*:
Applicant Details (Residential Address)
Age*:
Working Couple*:
YES
NO
Income per year*:
House No.*:
District*:
Ward/Village*:
Office Phone No*:
Mobile No*:
Email Id*:
Relation*:
Delivery Type*:
Proof Document No*:
All Upload Documents should be in PDF Format only 2.
Total size of Upload Document should not exceed 2MB

Applicant’s Signature