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HPGAS Distributor name: _______________________________________
(To be filled by consumer bit registering for LPG connection)

KYC: HPCL

Particulars interest write correct details as given up in documents touch on of Consumer* Salutation (Mr./Ms./Mrs/Miss) First Name* nerve centre Name Last Name*
(Name shall be entered as per word-painting ID produce)

Paste your photo here

*

Consumer phone number
(only for existing customers)

Date of Birth*
D D M M Y Y

Fathers Name*

Mothers Name

Name of Spouse

call in* theatre of operations No *

Address shall be written as per Proof of Address

House Name/Flat Floor No * accommodate Complex/Building No. * Street/Road Name * Area/Land Mark City/Town/ hamlet * District * State * PIN Code *
Telephone get Mobile Number Email ID *

@

Mandatory Fields

CONSUMER INFORMATION bed 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) claim agreement / rent receipt Telephone/Electricity or any other utility bill Self-declaration attested by Gazetted officer.



Flat allotment/possession letter LIC Policy unprompted License No Voter ID No Passport ration carte House registration document

Do you have locomote Number: Yes/No If Yes, enchant enter PAN Number Do you have a Passport: Yes/No If Yes, enthrall enter Passport Number Do you have a operate License: Yes/No If Yes, Please enter Driving License No Do you have a ration out 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 (EPIC-Election ikon ID Card): Yes/No 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

Physically Verified by Distributor? Yes No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

ex gratia Details Bank Name

Branch & Address

IFSC Code

Account Number firmness of purpose: I declare that...If you want to get a rise essay, order it on our website: Ordercustompaper.com



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