GuidelinesforReconstitutionofLPGDistributorship–2022

ANNEXURE-A2

APPLICATIONFORRE-CONSTITUTIONOFCOMMISSIONEDDISTRIBUTORSHIP
Date:
S.NO. PARTICULARS DETAILS
1 DetailsofDistributorship
(a) WhetherDistributorshipisonsoleproprietorship Proprietorship/Partnership/Others
orpartnership:
(b) NameofDistributorship SHEKHAR INDANE GRAMIN VITRAK
(c) SAP/JDECode 309932
(d) DateofCommissioningofDistributorship: 26/03/2018
(e) AgeofDistributorshipasondateofproposal: 5 YEARS 4 MONTHS
(f) Location: ZERDA
(g) Tehsil/Sub-Division/District: DEESA
(h) State: GUJARAT
(i) CategoryoftheDistributorship: SC/ST/Others (OPEN )
2 Detailsofexisting/deceased/incapacitatedproprietor/partner(s)
(a)
Nameof Category Alive/ Existing Wishtocontinue Proposed%share
Proprietor/ SC/ST/Others Deceased %share /retire
partner(s) /Incapacitated
VIJAYKUMAR J OPEN CONTINUE 50% CONTINUE 20%
DAVE
VARSHBEN V OPEN RETIRE 50% RETIRE 00%
DAVE

(b)
Nameof Address Telephone e-mailID
/Mobileno.
Proprietor/partner(s)

VIJAYKUMAR J DAVE AT- ZERDA TA. DEESA DIST 9824335292 vijaydavezerda@gmail.com

BANASKANTHA
VARSHABEN V DAVE AT- ZERDA TA. DEESA DIST 7698523574 varshabendave@gmail.com
BANASKANTHA

3 DetailsofLandonwhichDistributorshipis NEAR GOGADERI , AT&PO ZERDA , TA – DEESA , DIST -

located: BANASKANTHA
4 Whetherproposalforreconstitutionisbeingsubmittedonacco Resignation/Death/Incapacitation/Others
unt ofResignation/Death
/Incapacitation/Others:

5 Nameofthedeceasedorincapacitated 1.NA
Proprietor/Partner(s),ifsameisapplicable: 2.NA
6 Detailsofnominee(s),incaseappointedbydeceasedorincapacitatedProprietor/Partner(s):
(a) Whether nominee(s) was appointed by Yes/No
deceased or incapacitated Proprietor
/Partner(s): NA
(b) Name(s)ofperson(s)lastappointedasnominee(s) by the deceased or
incapacitatedProprietor/Partner(s),incasenominee(s)was/were Name Nameof %ofshar
appointed: (if more than one ofdeceased nomin e
nomineewasappointedbythedeceasedorincapacitated /incapacitate ee nominated
dProprietor

1
 GuidelinesforReconstitutionofLPGDistributorship–2022

Distributor(s) in his last nomination, details asindicated alongside has /Partner(s) (s)
to be given for eachnomineeindicatingthe
%shareoutproposedbyattachingseparatesheet).Ifthenominee(s)is/
areminor,thenthedetailsofthelocalguardianwhowillbeoperatingtheDist
ributorshiptillthenominee(s)becomesa
major, is to be furnished along with that of theminor nominee(s).

7 Detailofreconstitutionproposed
(a) Whether reconstitution proposed for induction ofoutsidepartner(s): Yes/No

(b) Whetherproposedforcompletechangeoverinconstitution: Yes/No

(c) Whether Distributorship is eligible for Yes/No

completechangeinconstitutionbasedonageofDistributorship:

(d) In case reconstitution is proposed within 3 yearsof commissioning of

Distributorship, whether Yes/No/NA
intheproposedreconstitution,51%shareisproposed

a) Infavouroforiginalallottee(s)and/orinfavourofnominee(s)/
legalheir(s)/familymember(s) (including married children, sonin % share out proposed, in case of death
law, daughter in law and grandchildren) ofDistributor(s) and in case of incapacitation
oforiginalallottee(s)wherereconstitutionisbeing proposed due to
death/ ofDistributor(s),wheretheincapacitated
IncapacitationofDistributor(s)andwhereincapacitatedDistributor( Distributor(s)desirestoretire
s)desirestoretire. In favour of original Infavourofothe
b) Infavouroforiginalallottee(s)wherereconstitution is being
allottee(s)and/ornominee(s)/lega rincomingpartn
proposed for reasonsother than death of the Distributor (s) or
isbeingproposedduetoothercases. lheir(s)/familymember(s) er(s)
(includingmarriedchildrensoninl
The % share out of proposed reconstitution is aw,daughterinlawandgrandchildr
tobeindicatedaspertablealongside.
en)of
deceased/
incapacitatedDistributor(s)

%shareoutproposedInothercases
Infavourofexistingpartner(s) Infavourofothe
rincoming
partner(s)

(e) If the Distributorship was allotted under SC/STcategory, whether Yes/No/NA

proposal is being submittedforinductionofothercategorypartner(s):

2
 GuidelinesforReconstitutionofLPGDistributorship–2022

(f) Incaseproposalisbeingsubmittedforinductionof partner(s) of other Yes/No/NA

category in Distributorshipallotted under SC/ST category, whether
total %share out proposed for other partner(s) is
within25%.Also,mentiontotalshareoutproposedforother category
partner(s) : (In case of Nameof Continuing %ofsharepr
death/incapacitation(duetoseriousillness/accidentresulting in total and partner(s) /Incoming oposed
permanent disability whichhas disabled the distributor (proprietor / ofSC/STcategory
partner)toworkorfollowanyprofession)ofSC/STProprietor/Partner(s),t
otalshareofthedeceased/incapacitatedProprietor/
Partner(s)canbetransferredtoNon-SC/STspouseorNon-SC/ST children
(legal heirs) as the casemaybe,whichwouldbecountedasSC/STshare)
Total
%sharepropose
dfor
partner(s)
ofSC/STcategory
Nameof Continuing %ofsharepropo
sed
partner(s) /Incoming
ofothercategory

Total
%shareproposed
forpartner(s)of
othercategory

8 Brief reasons for the

proposedreconstitution:
9 Name(s)ofcontinuingProprietor/Partner(s)
/incomingpartner(s):
(ifmorethanonepartnerisproposed,detailsasindicatedbelow Nameofcontinuing %ofshareproposed
hastobegivenforeachpartnerindicating the % share out Proprietor /
proposed). If thelegal heir(s) is/are minor, then the details
ofthe local guardian who will be operating Partner(s)
theDistributorship till the legal heir(s) becomesa major, is VIJAYKUMAR J DAVE 20%
to be furnished along with that oftheminorlegalheir(s).

Name of incoming %ofshareproposed

Proprietor/
Partner(s)

BHARATBHAI H 80%
CHAUDHARY

SignatureofexistingDistributor/Partner(s). Signature of the incoming partner(s)

(whereverapplicable)

Signature of nominee(s)/legal heir(s)/family

member(s)ofdeceased/incapacitated
(whereverapplicable)

Signature of Local
Guardian(whereverapplicable
)

3
 GuidelinesforReconstitutionofLPGDistributorship–2022

ANNEXURE-B2

UNDERTAKING

" I / We the existing Proprietor/Partner(s) M/s SHEKHAR INDANE GRAMIN VITRAK a Distributorship of
Indian Oil Corporation Ltd./Bharat Petroleum Corporation Ltd. /Hindustan Petroleum Corporation Ltd.
At ZERTDA ,District:BANASKANTHA ,State GUJARAT along with the
Propose dpartner(s) here byc onfirm that all the details furnished in the application are true to the best of my/our
knowledge. We also confirm that the re-constitution policy has been read and understood by me/us.I/We confirm that
the proposal for re-constitution is submitted consciously after fully understanding the implications of the same."

Signature of existing Proprietor/Partner(s) Signature of the incoming

partner(s)
(wherever applicable)

Signatureofnominee(s)/legalheir(s)/familymember(s)of
deceased/incapacitated Proprietor/Partner(s)(whereverapplicable)

SignatureofLocalGuardian(wherever
applicable)

4
 GuidelinesforReconstitutionofLPGDistributorship–2022

ANNEXURE-C2

DETAILSOFCONTINUINGPROPRIETOR/PARTNER(S)/INCOMINGPROPRIETOR/
PARTNER(S)FORRECONSTITUTIONOFCOMMISSIONEDDISTRIBUTORSHIP

1 Nameofthecontinuing/incomingProprietor/Partner(s)
 

2 Photographofthecontinuing/incomingProprietor/Partner(s)

ContinuingProprietor ContinuingProprietor
/ContinuingPartner /ContinuingPartner
/IncomingProprietor/ /IncomingProprietor/
3 Whethercontinuing/incomingProprietor/Partner(s) IncomingPartner IncomingPartner

Whethernomineeofdeceased/incapacitatedProprietor/ Yes/No/ Yes/No/

4
Partner(s) NA NA
Whetherlegalheir/familymemberofdeceased/incapacitatedProprietor/Partner(s) Yes/No/ Yes/No/
5
NA NA
WhetherincomingProprietor/Partner(s)isoutside/withinfamily Outside / Outside /
6
Within/NA Within/NA
CategoryofcontinuingDistributorship/incomingProprietor/ SC/ST/ SC/ST/
7
Partner(s) Others Others
8 %shareproposed 20% 80%
9 Address AT&PO – ZERDA, AT& PO- KOTADA ,
TA. DEESA, TA – LAKHANI ,
DIST- BANASKANTHA DIST- BANASKANTHA
10 District BANASKANTHA BANASKANTHA
11 State GUJARAT GUJARAT
12 PINCode 385535 385535
13 Telephone/Mobileno. 9824335292 9737791100
14 e-mailId vijaydavezerda@gmail.com Chaudharybharat1100@gm
ail.com
15 Educational qualifications on date of application HSC M.A, B.ED
16 Date of birth 15/12/1970 10/02/1993
17 Ageas on date of application 52 YEARS 7 MONTHS 30 YEARS 5 MONTHS
18 Present occupation BUSINESS BUSINESS
19 PANno. ABDPD8196J AWXPC8980A
Relationshipdetailswithexisting/deceased/incapacitatedProprietor/Partner(s),ifany - -
20

21 Anyotherrelevantinformation - -

Signature o fexisting Proprietor/Partner(s) Signature of the incoming partner(s)

(wherever applicable)

5
GuidelinesforReconstitutionofLPGDistributorship–2022