Form No. : VaDODARS Gas EVO Conoai Offer For GalLinda ud Ouroietees doin, ATEN oyistred Oe ‘Dandja Bear Man Road, Vadodara Website : www.vgl.co.in REGISTRATION FORM FOR SUPPLY OF PIPED NATURAL GAS TO DOMESTIC CUSTOMER 6c Baie Guallsi a2 For Office use only wre dd de: tide Renee Date of Receipt: aude, $PO en etl —_ bt DAR 20 22510 eULAL US PALA yeaa cuiAd youd gerd Aa Anaardlaed ea SHATA. Sin, () We inate aw owmer(sVoceupunte) ofthe Fsidential premises, wish to register for supply of piped natural gas to one designated place in the premises / property located at address mentioned below: (Please fill the form in BLOCK letters) (4€2Gief sala wn sl Sulea eaizni ai2)) 2424 (Surname) t-test Name) Raul +04 (oidate Name) year: ‘Namein full: aad elt dee: Mousa He: PhoneNo.(R): ‘Mobile No.: email: ‘uals Profession : Sear Address ade City: Pin Code: Duet as ioe = ‘Total Number of smily Members, ai el se oewaL AHL AA WN e/ Requested No. of extra Kitchen or Geyser Point zal a2 @gulaye): Bom adre Gyniay a): Kitchen Point (Max.2): Geyser Point (Max.1): dee suns 4 aaa AHR: way aa BiRaae: aaaid a. Loco} ya aaa ana OLA, de ae ad a waa 8) Receipt No. : Arie aysyelaifezcderel wait szar Hid (For Verification) 2A) wari aul 2 Alden yore caandriel ASwa A yall Fale tee Beal 2a) Attach photocopy of any two ofthe following document as a proof of residential address (Please tick). 9) Bat AE] Ration Card ¢) 4) eel wltnasit | Election Identity Card 2)2) Bed Rd Sasgls Mle [Latest Electricity Bil A) 5) MAW AMEN | Society Certificate 3) 3) Watell HBA Reset | caudadell tsa 2) 6) wulrs yRalua (Heda wale) - seule Ownership of Property Latest House Tax Bill (Local Municipal) Mandatory (Registered deed/Sale deed) Tol) "aden Sar RBS” ou gL “Lda sale 2b) Pay Onder or Cheque of Rs in favour of Vadodara Gas Ltd, (sare | deer | see | eple) Consent / Declaration $A hsm oid dM AA HUG PAE ay ag © Irented,then kindly provide the declaration (consent of ower) asunder ‘aziot mifeisefl eine Consent of Owner ga ue ret ala a8 from MHRA A wag GeAA Gell wag 2 Guz Yo Endl roujedaorri ater Aa HRs cra seed Aas nga HBA Muatsa aad Aa AS ale al, Tam the owner of above-mentioned properyisite & Thereby declare the I haveno objection is VADODARA GAS LIMITED camrying out Pipeline activites for providingpiped natal gas somnection atabovementionedpropertysite aztiRse-t Owner’smame: i | annie Owner's Signatures —_ Arta: PhoneNo. 2) eae uReed gan Mou, Heed “addeat Sa ARB ou se128 eM ALD AA ade” B ee AA AUaL Lea a2 aoariedlen 5288 3) Allinformation provided is true and correct. /We have read and understood the terms and conditions and will unconditionally abide| bythe same. fe) mar aA sarzaid areal AU Ais a. a daa Heal As MAAK ARM “adeada V2” ales aula Mas /auad 4) Please find enclosed Pay Order/Cheque No. dated drawnon, {favouring VADODARA| GASLID forthe sum of Rs, towards Registration Charges. pa) eumagrei ier arse See Poder asf asa ould) uvariauaa aud: aviary, Date: Yours faithfully, (oudesadl) (Signatureofthe Applicant) wala sean aid gro co}- danas LAL ysecun 22a, Pail g.A000)- M2 a aru Aarauasle2i dei faltids RY AUR MI MESS / MEH USUaUde alzt ge2l Ae yal uusar WZ add cadheat a ALAS (RUA, 6 2A Gee ary ase’ Hell 4A seared B) oe area abba oud arenas AeerEe GAL aall Pl Gdn uae’ hk seared ued.) aS ead gee la (6A WA ad Pl Gude den” ale sea Sued) yal usa n2 Fae. 19 aA wudad, AAMAsoUd w @ @ C) ) © @ 2) © (20) ay (a) (a3) (wo) Gy) (ae) sass, redac raa aur aed a st Racal AE ABA RRA YoU A WoUTYM aya usa HAarILya Usain dda wedleat ina eud. Guar ira alla wate usd sts att carn on, Wee Haru Rar eoBALA HA Ase MEA UY DA Ale (BURL aude HaCUEA Rareoreda3a) Hue HA ay AA ARE (Sue cary are) A Ala aH AULA TLD ya ucsad ae eRBaL NY ae RAL wa Paced ase) dul aa usd eaten ara see aaa ae sag ag sek OA yea HO AL Gs Ld LL Da, aurea, Mer yea el satya sear Saye se Se ae Sl a Sin A BHO 20d 4 tsa elu 2 LAA ssa Se Sue see aU LY, Gi ates LAU WeA HeALHLReAL sud od Gud go de Mar eee md 9 Reet Wa A ae Aue au, ae 3 sa Raed ASua ies, kay al aga. au gare donate Rate a a ALB eg AR ass Ren wa den a mere AINE AFA DSI yrs 4s, Moca et sguste Ue, 99 BA on a AA ea 2a, ts Aad aL HA Bau AT, He A A SA MY LATA at Yau Sedu sel yAest’, Waiver yal usaradg 2 Guero ade Bas aes BAA Alda eu UH Gear AZe Aas HLTA TU, a Shaye wuts Sel edt Ba a sss Sad ede see BAL 8 a Al wae SAA Gat eae, BAe ae AL ALS slbl-sis 3 Aa Gueoa sear 5 was eta 28 elle A Res Sue Rue} A ass A 2 ni rel us aya sae Sed Ag a4 usA MEL aeo ser acl aad ad Guede sear 2 asere Ga. OL ysl usa A aA yea ysl cae Sst RasRuenieta, madd Radel ume, sus DA sede 28 2 a yal se Hedl aRy ARR Rae a AON AlROAA sea sear earl acl ofl Mez-ainy, Rous, a wae, cera zed amar Ale MUNG seattle FA sed seared hea raL ARE APREA TA rade a oe ea a eset eaten ont asd Uae AMER NOO|-a Zeratul, Seuss det Sue saat Fa ers eA Se ARB ea ALB 54a OSL a9 yal tsa 1 a Ha a Deda seu wd, suse ea neat sud alia A ses ear Mee ALGAE Hi, a ALUG UR de eH AEN NOU AA, UH Ai, AAA UASE duds mater Aut ree ua oda MaPAA LLM yea ysl usa Meg aOAaA AA aden ASe Rd, sei, wLonRaL VA Aas ee Sa yalasa Berra 2a ll su DA aden MsdearA a, any sae A ied oll Re ysl 2B dl sean aa sua ae OA Fte we oa arlalaua dala Sela Rael yn snselaaaubel ae sel aaa er eeea oar yeaanel, Sayalrusee Sut ado Al subs ay oe ar MRAM aA 22a. Water Mead ada doe avatar Ted 628 wh Pe Aare sea ud 48 A a Usa We ae, 4A, se aL ee ASL ale Se yl vase Sef et ae a0, ea aL 2 ese Ran Ue, yl, Gus a aa aa UA aH Ysa sae eda 4a av Aue, arr ae eyed sae uA WR wea 3 Se uae aa A Aaya Use Fe tes waa ae seal sal ta, sad cas 25H oS 5A Uae Aad, Aa tse HUA ee alee? laae gall Ad sass Hire Rete ar aid dae See al ute AH ala AL HAS west we Me ala WH a Av dB ilRs Bea, 21d crea Reales Praca yeu’ ud Aare sear sudan cota eased aut esate eu ee sea a, sus, eyadrasa dull era aue sear ade el lad eed ys, Pan order rede added BA WB sear eda dine: yal edsearai ocd ell. rll ocala Sua aye Wo. yoo xara ee el ymUAA anes aaa aABoreared, A seni aye paar oud 22a oyuag. 1900/-seai a ag wl A AINE me mrs FeuML ere A yeas 4A Zar aa cure atl Coll qual ails, dl Be un Aoi ocd aaa wil yea 4d ag seal ued UKs eto ZU aed VA AGELLeAA ot edd aeucr daa usa Fadl Raga Sun geared eels wd we DSA4eoe yea oie sa Bard oad ed yea ga ag ee Fall ae Asean HUA ASMA He ae HR AA (eal) @ ag sea AeA OU a AA aed SAU Pel ysl andere Radon aa suai aed steer yea al Dea A Ba aa aul tas a see EB 3, WA ga dH AA ao Meare, seed, TAA star NOC A sMPsaLr aALAB? Anal 3 3A TRA are ed ard A 20 da De Pd Ree era ANON Gi Lea aU yal naa BEE AA sssered aver siren Guertin abate Mp ML ge usd Men F aed yal sed ha A you HA 5A A gE AA ea (1 MePseet wAABe) a8 Ada ang seal BAL A WAL A Sue deste 3 quad asd all. ced oases Hell uu A tea AT Ae 52. A suas AA Dl oa aver cee RAMA YU wuseraniaandd, AS our} ued eared ava )aud ddartear dae 3 olen a sal ara sed souseran dud. a uaa sea ua ad igre ous nse manned aac asca er A, ss en AONE EUR TLD A yeaa BSA DUA UME AA adage Radda Aauusa AAU MIRA RATA AMD yds’, MWsLaeyu yeastad ASUeL aed # A al A ys sae Helle sls ate eal usr seI ATA sae SLI sss ASL RAEA ew e832 suas TsPep a Syl warm Sea Mba ead a 43 ae, Sue by He ssl aye award 2A A aA (Alby) Peers Aue cae 3 Res ay 3 oausag yaa A raced es ea A suse BBdL, oad He ar i, DSNe sa HUBS Me aurdue ademas da ddl ade young 2,42, stalled Buss- cra, sts, Mayadas AA yoenr oe >A suse acubd Ta one Re eure oquar ea Meat 2 dal Beene aL Ges ay sae ell sara WAD, aryl eae Hel aL YALL| Betrell-na, Marredouarl aa, ade alberta sea.(a9) (ae) Qe) (20) (aa), (aa) (ea) @e) ee) (ee) Ge) (ee) Ge) (30) (er) Sayles He, ass ule mde le a aca, AWOL une Gis 3 awHeréed ea ABUoL, Pala Ham TM Bava 3 ade sarbdaridess2raHa ed, Says se AAA at wey ave FR MALL USCA dH AA, yea yA sal aed eA asa, al Be4Ue SRaLA, FA queer 2d, sue A usar ee oudaoed gue ad sad ed ae, HA Het Ral AAS AR HIN LA WAL a austell mess mde la seal Ba. 1S Rarer are ad ade aed Sen aad nadie 22a, suse, Gon Hse eneal sel a a HK HOA EA A Se ae SUA aA da EU AHA A AL TSNR eA) ALL seated rouse ten dua A aliounrdysadawarsreea, au sacl yea, yea a Subd, Beal 3 Mlerdznd ede axed As al ada a yal ise Se suse wel as ere ey sear el ane #9 eared, Stat yal sae Su Rae, a swe ged Roy sear a2, DAL aad suet eee sre Bom Feu, a YR SA Suda sas eae at ona a, erase de, 1 a es ela ou ae TOL el yea eee sere aU HL wala (0) Aayead sonal se seaiened duane (2) suseretredl yr, sued, daaluote HA HA Aol AWUa zane sca A due are seam AA ysl a2 aeladL ada co Gaalaica gael slant (3) sucditardgeat A AS a gz wert Aaland ret eH OUA uae ASU ALD aeag eee Healy, SOTA SAAR AGO Nays adalat Ge) susan dla soman aid ste ea A Bae Le, La ats HOTA, Ue LH ad BELA Eade, HAL aon atal (8) eo sued yu rd Alomadé sugar sat fe) suesara, Radar deddearel aaa Le wae YEAH MoverMavete sarin desea (0) sues, Aayalrusa du Mee ae Rasa aud sionearedsts Ferd Ae edgU 2 BUA Seale deere sd vee (c) suasaraPraorar lA yenstaurt sand arn aie Royene ur gsc sa otal Alaa (2) musrcen cai and dusted rend yea yal usar ae A HRA ta suds Ae yalutsae AAAS MR Pia Ata MSeDDyeAAL eh sea RA a ALA Mis 20(4) el (0) dam sete ia tera se ho dR, ke A el ds A AL an as aOR sul Me aH Nea Ysa ua, $12 Un at yal Ea Se ase sake ee eed Mow aL wa Got eed sara eae aera BEAL AA ea We sss mudd Rese selena larg ug ea, cevedart ona ese Me As 4a au eed sl eta (rg Manoel), a areas eat ag 4, sarcusai ned dad dative dhiniudladiand da 4. snusoupsudlaon artes oust 512 aH se SUOALAE 5. sou yeyabdolid mal esd Swe aon athoa a armada ele 6, sus ang art Aaadeaarceone sarsar ules sre dar asnadle, eatujounes acne aa au year Meal Hm 2A Ate vet ae sn ote a adaell sus Se audio carl eu soe Sa Seca seal yA ern nul eu A ge Aen eeu AsUd BAL Bou and ATA WAKE HAA, 15s, Mad aid en wduead au Seda? dud doustyral, ead a wed -w sous seal vance ee a. 2 Seal later Hae eanard vase HMA eee all au saree tea aed tad aren, dob eg ell El AA ae led HR Ae aA As ata ete wed eo AA sel Asad la ged soar Haan, use Gut wt 4 ce, 3 4 MAR BHAA DD Asta Matsa val ala STaHUA Gate A Ae Da SUE Pas wa aud wate sag aun ae Als et, a, AIR, Vee Dam OWE B te ey sea Ae aL Bt adeami-amaddlyagnaedd, Sere ee erga aH Wea Aaa sasT AS uevusie aur scarica allay gino adladl we B nua sean aaa aire al arias 58 sited ASHE A LOO/- ass HUAL AA (alee AA RRBS) Mysaacevda. eg ARR La Abe Ga ma A a alent adel Ss aig HadsrA our asic AL A aan Agar 2A, AH vA Aa arta yoru saad. ee Re HAgarr a sds. she aA AMIE weve ger ia” WA AGEs 5 ast, Ar ace Le PABA AoE wasdland. woman” a Asa Gee aneleouy 2, (wd aS ae ged ays sa? alee Ae RECA an ke seanaaltga guy oes me 49 BY A alan say 4% el af Gun ee ail 4d ee aed A eg A aD Aa Ase, ee B26 wal UAL AAA, yaad cl aaa aL aise 23 agar, uated eae Meena gg. masta aud (Signature ofthe Consemer) Dates 1