Declaration

I Desire to take domestic LPG Connection in my name and affirm as under: 1. That I am an Indian citizen or Non Resident Indian or staff of Foreign nationality serving in India or Foreign national residing In India under visa or person returning to India on transfer of residence basis / PIO. 2. I am above 18 years of age. 3. That neither I, nor any member of the household (household means a family consisting of husband, wife, unmarried children and dependent parents living together in a dwelling unit having common kitchen), possess any LPG connection from PSU oil Companies or piped Natural Gas Connection for domestic use in our dwelling unit. ('Households' having piped Natural Gas Connections are not entitled for Subsidizes LPG). 4. *I do not have Ration Card in my name or in the name of any member of my 'household as defined above. As and when a ration card is issued in my name or in the name of any of the members of the 'household' the same shall be produced to my LPG Distributor for updating Records. (applicable if copy of ration card is not produced & verified). 5. That I am enclosing the KYC form filled in along with the proof of address (POA) and proof of identity (POI). 6. I confirm that the LPG Connection issued to me will be used in my above mentioned address and for domestic cooking purpose only and I shall abide by all terms governing its use. 7. That I shall not position any other LP gas installation in the same kitchen. 8. That as and when second cylinder is issued to me against this connection the same will also be used in the same kitchen and with the original Installation. 9. That whenever I change my residence from present address to another, I will inform the LPG distributor in writing in advance for change of address in the records. 10. That I am aware that the domestic subsidized LPG connection as shall be released by M/s. Bharat Petroleum Corporation Ltd (BPCL) on the basis of this declaration and information submitted by me in the know Your Customer (KYC) form, Proof of Address, and proof of identity, shall later be subjected to de-duplication check for existence of any other domestic subsidized LPG Connection with any Public Sector Oil Marketing Company, in my name or in name of any other member of 'household'. 11. That If any information / declaration given by me in this undertaking the KYC form or any document submitted in support of identity / residence proof shall be found untrue or incorrect or false, BPCL would be within its rights to withdraw the supply of gas/ Terminate the connection / seize the equipment / forfeit the security deposit and that I would have no claim what so ever against BPCL for such withdrawal / Termination / Seizure. 12. I authorize BPCL to / share with my bank to update my Aadhaar No. and also to share my Aadhar no./demographic data/bank account details Public Sector Oil marketing Companies. 13. I further confirm to receive LPG Subsidy due to me into my bank account or give up my LPG subsidy based on the selection made above. 14. I request BPCL to link my aadhaar or bank a/c to my LPG account & I will advise changes if any to the Distributor/Company. 15. I shall not hold BPCL/MoP&NG responsible for any delays/non receipt of subsidy in case of change/closure /deactivation of my Bank Account/ Bank not in NACH or for any rejection by Bank or non-confidentiality of any information. 16. If aadhaar details not given: I don't have Aadhaar number & promise to submit Aadhaar as soon as I receive the Aadhaar number to my LPG distributor and also get it linked to my above Bank account. 17. I also understand that any false declaration made above attracts punishment under the Indian Penal Code. I hereby declare that whatever has been stated above is true to the best of my knowledge, correct and nothing material has been concealed in the form.