Customer Information
BP No. :
CA No. :
Application No. :
Name :
Father/Husband's Name :
Date of Birth :
Occupation :
Contact Information
Flat/Room No. :
Floor :
Wing :
Plot No. :
Building Name :
Colony :
Road Name :
Location :
Land Mark :
City :
Pin :
PAN No. :
Mobile No :
Telephone No.(Residence) :
Telephone No.(Office) :
Email ID :
Details of Meter installed at premise
Meter No. :
Meter Reading :
Documents upload
Gas Supplier :
Gas Distributor :
LPG Connection Number :
Name Transfer Reason & Status
Reason for Transfer of PNG Connection :
Name Transfer Charges (Including GST) :
Payment Status :
Name Tranfer Status :
Reject Reason :
[ Please note that a Convenience Fee of 0.90% + GST will be levied for Visa / MasterCard / RuPay Cards & 1.10% + GST for Amex Card transactions ]