MDBTL Version LO/i1-14
Sr. No. Form 2
LPG Linking Form
(To be submitted to LPG Distributor)
Step 1. Place your Original Aadhaar Letter* Step 2 . Take photocopy of this sheet & fill-up the
here as shown below: following details in the photocopy in BOLD BLACK /
BLUE inl
y \
1. NAME OF COMPANY (e.g. IOCL/BPCL/HPCL)
2. NAME OF DISTRIBUTOR
3. CONSUMER NUMBER (Attach a copy of first
page of DGCC booklet or recent cash memo)
}4, LPG ID (17 Digit No.)
5. NAME OF THE LPG CONSUMER
&. YOUR REGISTERED MOBILE NUMBER or MOBILE
NUMBER WHERE WE CAN CONTACT YOU
PE
7. ADDRESS (Fill this only if your present LPG
delivery address is different from address in the
Aadhaar Card, please attach a current proof of
address**)
Place;_____
Date:
jignature of the Consumer
Enclosures:
1. First page of DGCC booklet or copy of recent cash memo,
2: Photocopy of proof of address if your address with LPG
distributor differs from address in Aadhaar Letter,
in case you have an e-Aadhaar, please fold it vertically and keep the left side (the side with your photo
and Aadhaar Number as shown above) in the space provided above and follow the instructions as above
**address Proof (Photocopy of any one of the following):
* Aadhaar (UID) letter * Lease Agreement « Telephone or Electricity Bill or any other Utility Bill
* Self-declaration attested by Gazetted Officer + Flat allotment or possession letter « LIC Policy * Driving
License + Voter ID » Passport + Ration Card » House Registration Document,
ACKNOWLEDGMENT SLIP:
Received ‘Aadhaar LPG Linking Form’ from (Name), J Consumer
No. alongwith copy of Aadhaar.
Date: Sign & Stamp of Gas Distributor.