To,
__________ (Gas Connection Distributor Name)
__________ (Gas Connection Distributor Address)
Date: __/__/____
Subject: Request for New ________ (LPG/PNG) Gas Connection
Sir/Madam,
I, _______________ (Applicant Name), son of/ daughter of/ wife of _______________ residing at __________ ( Address) hereby solemnly affirm that I am _________ (citizenship ) Citizen and my date of birth is _________ (date of birth).
I hereby declare that I am not in the possession of any LPG connection and I will use the Gas for _________ (domestic) use only.
I request you to kindly issue a ________ (LPG/PNG) new gas connection in my name.
I am enclosing _________ (undertaking/affidavit/gas connection form/KYC documents) along with the application.
Thank you,
Signature: _____________
Your Name: __________
Mobile number: _________
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