Declaration

I Desire to take domestic LPG Connection in my name and affirm as under: 1. I hereby confirm that, the information furnished in this form is correct and nothing material has been concealed there from and I understand that, false information, if any will attract punishment under Indian Penal Code. 2. I shall not hold IOC/HPC/BPC/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. 3. In case of any revision/change in the above information ,I will inform the LPG distributor. 4. I authorize my Oil Company/my bank to update/share my Aadhaar No./demographic data/bank account details between themselves and with outside agencies for de-duplication/ authentication/ verification purposes. 5. In the event of any violation of Government Regulation related to the supply and distribution of LPG, IOC/BPC/HPC will be within its right to discontinue supply of LPG cylinders to me, forfeit of security deposit and levy of penal charges as per the policy and guidelines and may initiate legal action applicable under provisions 6. That I am an Indian citizen and residing in India 7. That neither I, nor any other migrated family members staying in the address given, posses any LPG connection from PSU Oil Companies or Piped Natural Gas Connection for domestic use in our dwelling unit. (‘Households’ having Piped Natural Gas connection are not entitled for subsidized LPG). 8. 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. 9. That I shall not position any other LPG gas installations in the same kitchen. 10. 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. 11. That whenever I change my residence from present address to another, I will inform my LPG distributor in writing in advance for change of address in the records. 12. That I am aware that the domestic subsidized LPG connection as shall be released by M/s. Indian Oil Corporation (IOCL)/Bharat Petroleum Corporation (BPCL)/Hindustan Petroleum Corporation (HPCL) on the basis of this declaration and information submitted by me in this 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 govt. Oil Company, in my name. 13. 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, the Oil Company would be within its rights to withdraw the supply of Gas/Terminate the connection/seize the equipments/forfeit the security deposit and that I would have no claim whatsoever against IOCL/BPCL/HPCL for such withdrawal/Termination/Seizure/Forfeiture. 14. I am willingly and knowingly sharing the Aadhaar numbers and aadhaar documents with OMC’s to avail the LPG connection 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.