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    MGL Registration Form PDF

    Uploaded by

    Anonymous mDQiXa4
    This document is a registration form for piped natural gas (PNG) from Mahanagar Gas Ltd. It contains personal details of the applicant such as name, address, contact information. It specifies the types of documents required for address proof and asks for payment details for the non-refundable application charges and refundable security deposit. The applicant declares that the information provided is true and accepts the terms and conditions for PNG supply.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    MGL Registration Form PDF

    Uploaded by

    Anonymous mDQiXa4
    275 views2 pages
    This document is a registration form for piped natural gas (PNG) from Mahanagar Gas Ltd. It contains personal details of the applicant such as name, address, contact information. It specifies the types of documents required for address proof and asks for payment details for the non-refundable application charges and refundable security deposit. The applicant declares that the information provided is true and accepts the terms and conditions for PNG supply.

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    MGL Registration Form.pdf

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    This document is a registration form for piped natural gas (PNG) from Mahanagar Gas Ltd. It contains personal details of the applicant such as name, address, contact information. It specifies the types of documents required for address proof and asks for payment details for the non-refundable application charges and refundable security deposit. The applicant declares that the information provided is true and accepts the terms and conditions for PNG supply.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    275 views2 pages

    MGL Registration Form PDF

    Uploaded by

    Anonymous mDQiXa4
    This document is a registration form for piped natural gas (PNG) from Mahanagar Gas Ltd. It contains personal details of the applicant such as name, address, contact information. It specifies the types of documents required for address proof and asks for payment details for the non-refundable application charges and refundable security deposit. The applicant declares that the information provided is true and accepts the terms and conditions for PNG supply.

    Copyright:

    © All Rights Reserved
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    12/11/2016

    MGLRegistrationForm

    PLEASEDONOTPAYBYCASH

    WG/O/32207/2016
    PrintT&C

    APPLICATIONFORMCUMRECEIPT

    ForRegistrationAndSupplyofPipedNaturalGas(PNG),
    IncompleteFormwillnotbeaccepted

    MAHANAGARGASLTD.

    (AjointventureofGAIL(India)Ltd.,BritishGas(U.K.)&Govt.ofMaharashtra)
    RegisteredOffice:MGLHouse,G33,BandraKurlaComplex,Bandra(East),Mumbai400051.
    CustomerCareOffice:Pay&AccountsBuilding,GroundFloor,BandraKurlaComplex,Bandra(East),Mumbai400051.
    IwishtoregisterforPipedNaturalGasconnectionintheappliedpremises.Mypersonalparticularsandaddressaregivenhereunder.
    PERSONALDETAILS
    MR./MS./MRS.

    FIRSTNAME

    MIDDLENAME

    SURNAME

    Ms. SASHIKALA

    VADAPALLI

    MALE/FEMALE

    DATEOFBIRTH

    PANNO

    AADHARNO

    OCCUPATION

    F
    7/1/1946
    AAEPV1728J
    INSTALLATION/CORRESPONDENCEADDRESS
    FLAT/ROOMNO

    FLOOR

    ROWHOUSE6

    WING

    RetiredLibrarian,I.I.T.Bombay

    PLOTNO

    Ground

    SECTORNO

    BUILDINGNAME

    SOCIETYNAME

    GRACEDIEU

    COLONYNAME

    GRACEDIEUCHSL

    LANDMARK

    GRACEDIEUCHSL

    CROSSROAD

    NEARD'MART

    AREA

    LOCATION

    CITY/DISTRICT

    HIGHSTREET
    PIN

    MUMBAI
    EMAILID

    400076

    MOBILENO

    sashiv98@gmail.com

    YOURRESIDENCEIS

    TELEPHONE(RES)

    TELEPHONE(OFF)

    9820284386

    [__]OWNED

    [__]RENTED

    [__]LEASED

    [__]COMPANYPROVIDED

    OWNER'SCONSENTTAKEN(PLEASETICK[__]YES) (IFYES/PLEASEATTACHNOCFROMOWNER)
    SUITABLEDAYFORINSTALLATION(EXCEPTSUNDAY&PUBLIC
    HOLIDAY)

    MAKEOFVEHICLE:______________FUELUSED:
    ___________

    APPLIANCESUSED:[__]GEYSER[__]AIRCONDITIONER

    REGNOOFVEHICLE:_________INTERESTEDTOKNOWMOREABOUTCNG:
    _______
    NO.OFFAMILYMEMBER[____]

    FORVERIFICATION
    Proofofownershipattached:(Pleasetick)
    [__]ElectricityBill
    DOYOUHAVEADOMESTICGASCONNECTIONINYOURNAME? NO

    [__]SocietyLetter/receipt

    NAMEOFTHELPGDISTRIBUTOR:

    LPGCONSUMERNO:

    PleaseDoNotPaybyCash

    PAYMENTDETAILS

    PLEASEPAYBYCHEQUE/DDDULYCROSSEDINFAVOROF"MAHANAGARGASLTD."
    CHEQUENO.
    CHEQUEDATE

    [__]Agreement

    BANKNAME

    AMOUNTPAID:(Pleasetickwhicheverisapplicable)
    [__]Rs.750/TowardsNonRefundableApplicationCharges
    [__]Rs.5000/TowardsRefundableSecurityDepositfortheConnection
    [__]Rs.750/TowardsRefundableSecurityDepositforGasConsumption

    BRANCHNAME

    DECLARATIONBYAPPLICANT
    1.I/Wesolemnlydeclarethattheparticularfurnishedabovearetrueandcorrect.2.I/WeconfirmthatI/Wehavereadand
    understoodthetermsandconditionshostedonthewebsite.3.I/WeacceptandagreetothesaidTermsandConditions
    asprevailingfromtimetotime.4.IacceptthatMahanagarGasLtd.isentitledinitsabsolutediscretiontoacceptorreject
    thisapplicationforRegistration,withoutassigninganyreasonwhatsoever.5.IauthorizeMahanagarGasLtd.toverify
    theinformationstatedinthisformwhatsoeversource.IagreetosurrenderLPGconnectionwithin60daysofactivationof ApplicantSignature
    PNGconnection.
    DATEOFONLINESUBMISSION:11/12/2016
    NAME:__________________________
    DATE:
    Note:1.IfBusinessPartnernumberisnotreceivedwithinonemonthyoumaypleasecontactourcustomerserviceon1917/26594500,2/61564500.
    2.ChequesubjecttorealizationinMahanagarGasLimitedA/c.Pleasenotethatincaseofdishonourofacheque,Rs.200.00shallbepayablebythe
    customertowardsadministrativecharges.Thisisprejudicetoallourrights.3.ApplicationChargesofRs.750/isnonrefundableexceptincaseof
    "TechnicallyNotFeasible"consumer.ThedecisionofMahanagarGasLimitedinthisregardshallbefinalandbinding.ToknowaboutT&CforPNGsupply
    todomesticconsumes,pleasevisitwww.mahanagargas.com.Anyextrachargeasstatedunderclause5.2oftermsandconditionshostedonthe
    website,shallbechargedtothecustomerinitsfirstbill.Thechargesshallbeleviedasperthestandardratecardavailablewithcontractorandalsoon
    websiteofMGL.AnybodydemandingcashobtainingPNGconnectionortowardsextrachargemustbebroughttothenoticeofVigilanceDept.Please
    mailatvigilance@mahanagargas.com

    FOROFFICEUSE

    (PLEASETICK:)
    [__]VIP
    CONNECTIONOBJECTNO.

    BPNO._______________________________________________________________________
    DRS
    AGENCYCODE

    2000065630

    0005

    SERVICEREGULATORNO.

    AGENCYNAME

    MMUS06D00500050100501507
    VERIFICATIONDATE

    SUPERVISORNAME

    RRFCONTROLNO

    VERIFIEDBYMARKETINGINCHARGE
    EMPLOYEEID
    SIGNATURE

    SIGNATURE&STAMPOFPMCOFFICIALS

    ReceiptforApplicationsubmitted

    ReceivedyourapplicationthroughourwebsiteSubmittedon

    11/12/2016 PleasepaytheSumofRs.6500/.

    https://www.mahanagargas.com/MGLModule/print_form_nopay.aspx?token=32207

    1/2

    12/11/2016

    MGLRegistrationForm

    Applicationfeeswithin10workingdaystoenableustoprocessyourapplication.

    https://www.mahanagargas.com/MGLModule/print_form_nopay.aspx?token=32207

    2/2

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