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SUI SOUTHERN GAS CO. LTD.

APPLICATION FORM FOR DOMESTIC CONNECTION

SERVICE
SKETCH AREA NO. TARIFF MONTH YEAR CODE

No . 1

CONTRACTOR CODE FILE NO. R/T

1

FULL NAME AND ADDRESS OF CONSUMER (IN BLOCK LETTERS)

N.I.C. NO.:

CONTACT ADDRESS

POSTAL TELEPHONE NEAREST EXISTING NEAREST EXISTING

CODE NO. GAS METER NO. CONSUMER A/C NO.

FUEL COST OF FUEL INCOME PROFESSION FAMILY

CODE CODE CODE CODE SIZE

01 = LPG 01 = LESS RS. 50 01 = POOR 01 = SERVICE 01 = UP TO 4 NOS

02 = KEROSENE 02 = 50 - 100 02 = LOWER MIDDLE 02 = BUSINESS 02 = 5 TO 8 NOS
03 = WOOD 03 = 101 - 200 03 = MIDDLE CLASS 03 = OTHERS 03 = 9 AND OVER
04 = OTHERS 04 = 200 04 = UPPER CLASS

CONTRACTORS NAME: _____________________________________________________________________________________________________

GAS PIPELINE INSTALLATION HAS BEEN COMPLETED AS PER ATTACHED SKETCH AND STANDARD LAID DOWN BY SUI SOUTHERN GAS CO.
LTD. AT THE ABOVE-MENTIONED PREMISES.
WE UNDERTAKE THAT IF ANY PIPE-FITTINGS, COCKS, ETC., ARE FOUND DEFECTIVE AT ANY STAGE, SUI SOUTHERN GAS CO. LTD. WILL
BE WITHIN ITS LEGAL RIGHTS TO REPLACE THE SAME AT OUR COST.
PLEASE ACCEPT PAYMENT OF SSGC FEE/CHARGES THROUGH ATTACHED
P.O. NO. ___________________________________ DATE ________________________________________________
OF ______________________________________________________________________________________ BRANCH
FOR RS. _________________________________ AND INSTALL CONNECTION.

______________________________ _________________________________ _________________________________________

SIG. FITTERS (REG. NO.) SIG. SUPERVISOR (REG. NO.) CONTRACTORS SIG. AND STAMP

Sui Southern Gas Co. Ltd. Domestic Connection Application Form

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FOR USE BY SSGC SALES DEPTT.

CHECKED, FOUND IN ORDER. PLEASE ACCEPT PAYMENT OF RS._______________________ DATE ___________________

SIGNATURE

OFFICIAL RECEIPT WILL BE PRINTED DATE RECEIPT NO. M/C NO. AMOUNT RECEIVED SKETCH NO.
BY MACHINE IN THIS SPACE

CHEQUES ARE NOT ACCEPTED

CONNECTION CHARGES GAS SUPPLY DEPOSIT ADVANCE BILL PAYMENT TOTAL

Sui Southern Gas Co. Ltd. Domestic Connection Application Form