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.:
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