INDO BRIGHT PETROLEUM PVT. LTD.

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IBP GAS FRANCHISE

Types of Franchise :-

Cylinder Franchise
Dealership Retail Outlet

Auto LPG Franchise

Reg. No.

State

District

Category

Misc.

Name of the Firm

(applied for)
Registration No. INDO BRIGHT PETROLEUM
PVT. LTD.

Expression of interest for setting up IBP Gas Franchise

1.0 PERSONAL

1.1 Name of applicant :

Father Name :
Photograph

D.O.B. : of
Applicant

Nationality :
Name of the firm(applied for) : :
1.2 Address for communication :
District : Photograph
of
Applicant
Pin Code :
State :
1.3 Contact Nos. :
Residence with (STD) code :
Office with (STD) code :
Office with (STD) code :
Mobile :
E-mail Id :
(Please provide name and contact nos. of a person to be contacted in your absence)

1.4 Contact person name :

Residence with (STD) code :
Office with (STD) code :
Office with (STD) code :
Mobile :

2.0 OCCUPATION/BUSINESS DETAILS

2.1 Current occupation (If individual) :

2.2 Current source of income
(if individual) :
2.3 Current business (If firm) :

2.4 Name of the firm/s (If existing) :

2.5 Type of firm : Proprietorship Partnership Public Ltd. Private Ltd.
2.6 Turnover of the company :
2.7 No. of employees employed :
2.8 Will this proposal be your primary /
additional source of income? : Primary source Additional source
Registration No. INDO BRIGHT PETROLEUM
PVT. LTD.

3.0 OIL INDUSTRY EXPERIENCE IF ANY

3.1 Any previous experience in

petroleum industry? : Yes No
(If yes, please attach separate sheet
to provide more details with
respect to experience)

3.2 Any family members involved in

the petroleum business?
(If yes, please attach a separate sheet
to provide more details) : Yes No

3.3 If dealing in retail petroleum business

please provide following information
of your dealership License No.
a) P.E.S.O. Lic. No. of the firm :
b) Name of the company :
c) Name of the dealership & address :
d) Operating since :
e) Sales volume per annum
(Product-wise) : Domestic LPG Commercial LPG

4.0 SITE PARTICULARS

4.1 Land available for development : Yes No

(If yes, please provide the following details

A) Site/Location address
Survey no./Gut no. of the plot :
Plot/Property address
Village
Taluka

District State
National Highway No. State Highway No.
Major District Road No. City Road No.

B) Site dimensions :
Size of site [Length and Width (Mtrs.)] :
Frontage of site (Mtrs.) :
Length of plot along the road :
Total land of plot along the road :
Total land areas (Sqr. Mtrs.) :
Site plan (Please attach a sketch of the plot showing dimensions of the plot and also of the road
on which the plot is situated)
Please attach photographs of land / surrounding area
C) Site within/ outside city limits :
Distance from nearest city/town :
 Registration No. INDO BRIGHT PETROLEUM
PVT. LTD.

5.0 LANDMARK FOR THE SITE

5.1 Distance of nearest Km stone

from the plot (Mtrs.) :
5.2 Location of the Km stone : Same side of the plot or Opp. Side of the plot
And
LHS with respect to plot or RHS with respect to plot
5.3 Description on the Km stone :
5.4 Nearest road junction :

6.0 OTHER SITE DETAILS

6.1 Name of the land owner :

What is your relationship

with the owner? :

6.2 Are all documents relating to

the property clear? : Yes No
(attach copies of all documents)

6.3 Are you willing to give the land/

property on long term lease to IBPL : Yes No
(In case of Auto LPG)
6.4 Status of land : Agricultural Not Agricultural
(If agricultural, indicate time to
convert for non agricultural use) :

6.5 Is power connection readily available? : Yes No

(If no, indicate time required

to get the power connection) :
{in case of Auto LPG}

6.6 Is there any electrical wire

passing over your site : Yes No
if yes : High Tension(HT) Low Tension(LT)

6.7 Is water connection available readily? : Yes No

(If no, indicate time required
to get the water supply) :
(in case of Auto LPG)

6.8 Are motorable approach roads to

your land/property existing? : Yes No

(If no, what is the plan

for development) :
Registration No. INDO BRIGHT PETROLEUM
PVT. LTD.

7.0 ESTIMATED SALES AND EARNINGS

7.1 Estimated potential of sale from

proposed site :Domestic LPG. CYLINDERS/MONTH
Commercial CYLINDERS/MONTH
Industrial MT/MONTH
Auto LPG MT/MONTH
7.2 What is your expectation of earning per month from the dealership?
(Make a rough calculation of your earnings using industry margins and prices and
for the services you propose to offer)(only for Auto LPG)

Sales of Auto LPG :

Servicing of vehicles :

Selling tyres, tubes, batteries :

Spare tyres :

Medicines :

Food joint/Dhaba :

Consumer goods :

Communication centre :

(STD / ISD / Internet) :

Fertilizers / Pesticides :

Any other :

(Please list details product-wise) :

8.0 INVESTMENT PARTICULARS

8.1 Indicate amount you are willing to

invest in the retail outlet business : Rs. 5 to 25 lakhs Rs. 25 to 50 lakhs
Rs. 50 to 100 lakhs More than Rs. 100 lakhs

8.2 Source of fund : Own funds Rs. Loan Rs.

%Own %Loan
 Registration No. INDO BRIGHT PETROLEUM
PVT. LTD.

DECLARATION

I shree..................................................................................hereby declare on solemn affirmation that I

Shall follow and accept all terms and conditions given by the company, I also declare that I
shall do my level best to complete the target for supply of goods within prescribed time by the
company. I agree with the term of non-refunding of Registration amount i.e. Rupees forty thousand Only once
the processing has been done.

The above application and declaration is true to my knowledge and belief.

Photograph Photograph

Applicant's Signature Partner's Signature

Please submit the following documents along with application :

1) Identitiy Proof of the applicant and partner if any ( PAN Card / Voter ID)
2) Address proof of the applicant and partner if any (Ration card / Election Card / DL )
3) 3 Photograph of applicant and partner if any should be affixed on to the form
4) Blank Stamp Paper of Rs. 500/-
5) Cash / DD of Rs. 40000/-

ENCLOSURES

(Please mention the documents you will be attaching with the completed form)
1. 4.
2. 5.
3. 6.

Terms and Conditions

1. The data asked for in this form is purely to evaluate your "Expression Of interest" (EOI) for putting
up a retail outlet for LPG.
2. Submission of this form does not guarantee award of dealership.
3. Forms not complete in all respects may be rejected.

I agree with the above terms and conditions.