FORMAT FOR TRANSFER OF DOMESTIC LPG CONNECTION To

FORMAT FOR TRANSFER OF DOMESTIC LPG CONNECTION

To,

Name & Address of the Distributorship:-M/s_________________________________________________

From: Name of the Transferor:-___________________________________________________________

Address Of the Transferor:-______________________________________________________________________

Subscription Voucher (SV) number:- ____________________dated _____________ Consumer No :____________

Name of the Transferee: - _______________________________________________________________________

Address of the Transferee:-______________________________________________________________________

Relationship with Transferor:-____________________________________________________________________

Type of transfer/ Type A:-Transfer by Subscriber to family member

Regularisation Type B:- Transfer Outside family

(Tick the appropriate Type C:- Transfer without consent letter from Transferor

Box) Type D:- Transfer to next of kin in case of death of Subscriber

Type E:- Regularisation of connection (LPG equipment held without possessing SV).

Declaration by Transferer (Strike off if Not applicable)

I Mr./Mrs/Ms _________________ , am no more in need the abovementioned LPG connection and request you

to transfer the same to the transferee. I hereby authorise you to handover the security deposit amount held

in my name to Mr./Mrs/Ms……………………… . I hereby confirm that I will not have any claim at a later date on you

in respect of the said LPG connection or the equipment / security deposit towards the same.

Name___________________Signature __________________Date ____________Place_______________

Declarations by Transferee / Regularised consumer

I, Mr./Mrs/Ms __________________ an Indian Citizen above 18 years of age, hereby confirm that I will submit

documents required for the LPG connection, deposit security amount for loan of the LPG equipment as per your

terms and conditions. I request you to transfer the abovementioned LPG connection in my name OR issue

Subscription Voucher in my name for the equipment presently held by me without SV (Strike out whichever is not

applicable).

I hereby undertake to indemnify M/s Indian Oil Corporation (IOC)/Bharat Petroleum Corporation

(BPC)/Hindustan Petroleum Corporation (HPC) against any claims whatsoever arising in respect of the LPG

connection transferred / regularised in my name and the equipment/ security deposit thereunder.

I also affirm as under:-

 That I am not in possession of LPG connection of IOC/BPC/HPC for my domestic use, either in my name

or in name of any of my family members residing with me in the same dwelling unit.

 That my household is independent of other households or kitchens if any within the same address.

 That if any information/declaration given by me in this undertaking or any document submitted by me for

availing this LPG connection whether in support of KYC/identity/date of birth/residence proof/Death

certificate etc., shall be found untrue or incorrect or false, IOC/BPC/HPC would be within its rights to

withdraw the supply of Gas/terminate the LPG connection/seize the equipments/forfeit the security

deposit & that I would have no claim, whatsoever against the IOC/BPC/HPC for such

withdrawal/termination/seizure/forfeiture.

I hereby verify and confirm that what has been stated above is true to the best of my knowledge and nothing

material has been concealed therefrom.

Name_____________________Signature __________________Date ____________Place____________________

_______________________________________________________________________________________

Declaration By Distributor

I confirm having physically verified the above premises on______________ and found it to be an independent

household with separate Kitchen at the address_________________________________________________

Name of visiting Distributor’s Representative ______________________

Signature_________________ Distributor’s Seal & Signature

Format for Transfer of Connection Ver.1-BPC/14