Application for Liquid Petroleum Gas (LPG) Consumer Card/Book

Application for Liquid Petroleum Gas (LPG) Consumer Card/Book:
Date:
The Regional Director
Regional Trade & Industry Office
Ministry of Economic Affairs,
…………………………………………...
Sir,
I would like to request for a LPG consumer card in accordance with the procedure and system in
place and my personal details are as furnished here below:
I.
Name
II.
Bio-data:
CID
number
Residential
address
Permanent
address
Contact No.
Details of the house-hold members (dependents) living with me:
Sl. No
III.
Occupation
Name
Age
Citizenship ID No.
Number of Cylinders purchased from the respective dealers:
BOD/BOC
DPD
DPCL
Please find attached herewith a copy of my citizenship identity card along with a passport size photograph. I also, hereby, declare that the information furnished above is true to the
best of my knowledge.
Affix
Legal
Stamp
Verified and approved by:
Signature of the applicant
Signature:
Name:
Consumer Card No.: