CONSENT FORM FOR DENIAL BY CUSTOMERS /

TNF(CUSTOMER NOT INTREST FOR CONVERSION)

Project : City Gas Distribution Project in Vrindavan

Client : GAIL Gas Limited
Consultant : Mecon Limited
Contractor Name : SCPL
(To be filled by the contractor)
Customer Name: __________________________________________________________________________

Address: ________________________________________________________________________________

________________________________________________________________________________________

BP No. : ______________________ Telephone No.: _____________________________________________

Technically CUSTOMER or Not : _________________________________________________________________

If Feasible, Ready for Conversion (Yes/No) _____________________________________________________

(Tick “√” the applicable case of customer’s consent for denial of work and explain the reasons below)

For non-conversion For non-installation of PNG Conn. For Non-Laying of Service Line

Reasons:
___________________________________________________________________________________________
__________________________________________________________________________________________

 If Ready to Convert to Natural Gas at a later date, please mention date and time:
____________________________________________________________________________________
Meter No.: _______________________ Initial Meter Reading: ________________________________________

Meter Make: ________________________________________________________________________________

 In case of House Lock (visit records):
DATE TIME

Contractor Representative Mecon Limited Engineer’s

Customer’s Signature with Name Name & Signature Name & Signature