Permanent Disconnection

I ……………................................... (Son of/Wife of) having form no/ customer no……………………… want to

surrender the PNG connection which is provided by AGL due to……………………………………….............................

For the same I am submitting hand written application with disconnection reason along with original acknowledgment

slip (if not available then Notarized Affidavit) and ready to pay the disconnection charges which is applicable as per

company policy and I also agree to clear all the dues before proceeding for the disconnection of PNG connection.

CHARGES DETAILS
Complaint Category Unit Services (Excluding GST) Applicable Visit Charges
Permanent Disconnection
GI Pipe/mtrs. (1/2”) = Rs. 69/-

GI Pipe/mtrs. (3/4”) = Rs. 74/-

Mtr. Copper Pipe/mtrs. = Rs. 71/- Rs. 150/-

*(Disconnection Charges (as per AGL norms)
would be levied and payable by the
GI Pipe/mtrs. (1”) = Rs. 81/-
customer. Only then, Refund cheque
procedure will be initiated.

Note: - If customer having two connections in his premises and wanted disconnection of one connection due to any reason
then the pipe exceeding from the first connection will be added to remaining connection and payable by customer as per
prevailing policy. Extra pipe amount will be charged @Rs 413/meter including GST.

I hereby declare that all the documents submitted by myself along with this declaration is correct and as per my best
knowledge. If I fail to pay the charges levied by company against PNG connection, then company is liable to take any
kind of legal action accordingly, For recovery of dues, If any.

Date: -
Place:
Contact no: -
Customer’s Signature

*t&c apply