Format for Declaration – New LPG Connection, India

Format for Declaration –  New LPG Connection, India

Hello folks,

Recently I was kind of struck by lightning when I saw my electricity bill….and after much self-searching, I concluded that the Induction cooktop was the culprit! So I applied for gas.

I was given a form and asked to get it typed …..leaving out couple of things irrelevant in the form.

Why on earth should I type..or get it typed? I should just be filling up the form. Period!

But No! I had to get it typed! I found it rather ridiculous…I searched google to find if someone has uploaded editable text of the form…NOPE – not there!

Anyway folks, since I took the efforts of OCR-ing it etc. I am uploading this form – so that anyone requiring this can just copy paste and replace name and address and submit! Hope you appreciate my endeavor!

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(To be submitted by persons desirous of New LPG Connection or connection against Termination Voucher)

Declaration

I, ________________, daughter/son of ______________________, age ________ years, resident of _________________________ desire to take domestic LPG connection in my name and affirm as under:

1.That I am an Indian citizen.

2. That my date of birth is _____________ (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 in our dwelling unit. (Households’ having Piped Natural Gas connection are not entitled for Subsidized LPG)
4. That I do not have Ration Card in my name of in the name of any member of my ‘household’ as defined above. As and when a ration card is issued in my name or in the name of any of the members of the ‘household’, the same shall be produced to Oil Company LPG distributor for updating records.
5. That I am enclosing the KYC form duly filled in along with the Proof of Address (POA) and Proof of identity(P01)
6. I confirm that the LPG 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 position any other LP 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 _____________ in writing in advance for change of address In the records.
10. That I am aware that the domestic subsidized LPG connection as shall be released by M/s. Indian Oil Corporation (IOU) on the basis of this declaration and information submitted by me in the Know Your Customer (KYC) form, Proof of Address, and Proof of Identity, shall later be subjected to de-duplication check for existence of any other domestic subsidized LPG connection with any govt. Oil Company, in my name or in the name of any other member of my ‘household’ as at para ‘3’ above.
11. That if any Information / declaration given by me in this undertaking, the “KYC’ form or any document submitted in support of identity/ residence proof shall be found untrue or incorrect or false, the Oil Company would be within its rights to withdraw the supply of Gas/Terminate the connection/ seize the equipments / forfeit the security deposit and that I would have no claim whatsoever against IOCL for such withdrawal/ Termination/ seizure/ forfeiture.

I hereby declare that whatever has been stated above is true to the best of my knowledge, correct & nothing material has been concealed there from.

Date: _______________                                                                  

Place : _______________

Signature of person giving the declaration

Name: _____________________

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