Registration Panel Window

📝Application form

Title: The location selection for LPG dealership, Type of RO: regular , Mode of selection: Draw of lots Retail Outlet Eligibility Criteria for Land 15 X 15 Sq.M. (Mininum Size)

👤Personal Information

Frist Name *

Last Name

Mobile Number *

Res. Address *

Pincode *

State *

District *

Email Address *

PAN Number *

Whether Applicant is Indian Citizen *YesNo

Physical Disability *YasNo

Date of Birth *

Father/Husband Name *

Marital Status *(In case of married women Husband's Name)SingleMarriedWidowerDivorce

🎓Applicant's Education Qualification (Minimum 10th pass or Equivalent)

Qualification *

Board/University/Institute *

Year *

Name(s) of the owner of Land/Leaseholder *

Relationship with Application *

Khasra No / Khatouni / Gut No / Survey No *

Location of the Land *

Dimension of Land

Frontage in Meter *

Depth in Meter *

Area (Sq.M) *

are you efilling to transfer the land on sale / long lease of the LPG Gas DealershipYesNo

✅Declaration

🪪 Applicant Photo

Applicant Photo *

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Applicant Address Proof *

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PAN Card *

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