KYC - BharatGas

Know Your Customer (KYC) Form

*Mandatory Fields
Only A-Z, a-z, 0-9, Comma (,), Hyphen (-) and Slash (/) are allowed. No other special character is allowed in any entry field.
Request For New Connection

1) Personal Details

Salutation*:

First Name*:

Middle Name:

Last Name*:

Date Of Birth*:

(DD-MM-YYYY)

Close Relative

Father's Name*:

OR Spouse Name*:

Mother's Name*:

2) Address for LPG connection / Contact Information

Proof of Address ( POA ) click here to know list of accepted documents

POA Category*:

POA Detail*:

House / Flat #, Name*:

Floor No*:

Housing Complex/Building*:

Street/Road Name*:

Land Mark*:

City/Town/Village*:

State*:

District*:

Distributor:

Pin Code*:

Mobile Number*:

Telephone Number
(With STD Code without prefixing '0'):

Email ID*:

3) Other Relevant Details

Proof of Identity ( POI ) click here to know list of accepted documents

POI Category*:

Card Number*:

Ration Card Details if Available:

State Of Issue for Ration Card:

Ration Card Number:

4) Details Related to Cash Transfer

Government has launched the 'Give Up Subsidy' scheme which is aimed at motivating LPG users who can afford to pay the market price for LPG, voluntarily surrender their LPG subsidy.

If you want to give up subsidy, select 'Yes' below. If you want subsidy, select 'No' below:

Yes

Choose an option:

I have Aadhaar

I do not have Aadhaar

IFSC Code:

Bank Name:

BankName

Account Type:

Bank Account No:

Confirm Bank Account No:

Your Name as per Bank Account:

5) Document Submission

Submit Photograph and required supporting documents

Upload Online

Submit to Distributor

I hereby declare that whatever has been stated in declaration is true to the best of my knowledge, correct and nothing has been concealed in the form.

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