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    Hig Decl 2016 PDF

    Uploaded by

    Ravi Kumar Sandhu
    This document contains a declaration form for LPG subsidy eligibility. The form requires the consumer to provide their name, LPG ID number, distributor details, and to check a box indicating if their annual income or their spouse's annual income is above or below Rs. 10 lacs. It also requests the consumer to provide their and their spouse's PAN number or indicate that they do not have a PAN. The consumer must sign and date the form, and the distributor will provide an acknowledgement slip upon receiving the completed form.

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    Hig Decl 2016 PDF

    Uploaded by

    Ravi Kumar Sandhu
    14 views1 page
    This document contains a declaration form for LPG subsidy eligibility. The form requires the consumer to provide their name, LPG ID number, distributor details, and to check a box indicating if their annual income or their spouse's annual income is above or below Rs. 10 lacs. It also requests the consumer to provide their and their spouse's PAN number or indicate that they do not have a PAN. The consumer must sign and date the form, and the distributor will provide an acknowledgement slip upon receiving the completed form.

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    HIG_DECL_2016.pdf

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    This document contains a declaration form for LPG subsidy eligibility. The form requires the consumer to provide their name, LPG ID number, distributor details, and to check a box indicating if their annual income or their spouse's annual income is above or below Rs. 10 lacs. It also requests the consumer to provide their and their spouse's PAN number or indicate that they do not have a PAN. The consumer must sign and date the form, and the distributor will provide an acknowledgement slip upon receiving the completed form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    14 views1 page

    Hig Decl 2016 PDF

    Uploaded by

    Ravi Kumar Sandhu
    This document contains a declaration form for LPG subsidy eligibility. The form requires the consumer to provide their name, LPG ID number, distributor details, and to check a box indicating if their annual income or their spouse's annual income is above or below Rs. 10 lacs. It also requests the consumer to provide their and their spouse's PAN number or indicate that they do not have a PAN. The consumer must sign and date the form, and the distributor will provide an acknowledgement slip upon receiving the completed form.

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    of 1

    HIG Ver 1.

    0
    DECLARATION OF INCOME FOR AVAILING LPG SUBSIDY
    Consumer Details

    Consumer Name Mr / Mrs

    Consumer No

    LPG ID

    Distributor Details

    Distributor Name M/s

    Dear LPG Distributor,


    I am aware that, as per the directive of Govt of India, dated 28/12/2015, LPG subsidy will not be available for LPG consumer, if the
    consumer or his/her spouse had taxable income of more than Rs 10,00,000/- ( Rupees Ten Lacs) during the previous financial year
    computed as per the Income Tax Act, 1961.

    1. My or my spouse's annual income is more than Rs 10 Lacs

    2. My or my spouse's annual income is less than Rs 10 Lacs


    } Please check the appropriate box

    PAN Details

    PAN No *(Consumer) I don't have PAN

    PAN No * (Consumer's Spouse) I don't have PAN

    * Pleae attach self attested copy of PAN Card

    The information furnished above is correct and I understand that, false information, if any will attracts punishment under Indian
    Penal Code.
    In case of any revision in my / spouse's income level for subsidy eligibility, I will resubmit the declaration.

    Date _____________________ Place_________________________

    Signature of the Consumer

    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    ACKNOWLEDGEMENT SLIP

    Received Declaration of Income from (Name)________________________________________________Con. No _____________

    Date: Sign & Stamp of LPG Distributor

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