֏֞֒ֆ֌֧ᮝ֑֫֟֔֐շ֩֌ᲃ֧֒֘֊֟֔֟֐ց֧փ ձ֚֗֠ց֠֗֠ց֠ձᮧ֌ᮢ

֏֞֒ֆ֚֒շ֞֒ի֌ᮓ֐ SV/TV/TA- FORM

֌եվ֠շ֣ֆճᳰ֍֚ն֒շ֒֠֐֏֑֩֒֫փ֌֫֎֩᭍֚֊֧֗֔֞փᭅթ᭭ց֧ց֐֡ե֎ժ
BHARAT PETROLEUM CORPORATION LIMITED
(A GOVERNMENT OF INDIA ENTERPRISE)
REGISTERED OFFICE: BHARAT PETROLEUM CORPORATION LIMITED, BHARAT BHAVAN, 4& 6, CURRIMBHOY ROAD,
BALLARD ESTATE, P.B.NO. 688, MUMBAI - 400 001, CIN : L23220MH1952GOI008931 PHONE : 2271 3000 / 4000 FAX : 2271 3874
EMAIL : info@bharatpetroleum.in WEB: www.bharatpetroleum.in

S. NO. SV-4126365062 DOCUMENT TYPE SUBSCRIPTION VOUCHER

ֈ᭭ֆֶ֧֞֗ᮓ֐֞եշ ᳰֈ֊֞եշ ֟ֆ֟և֐֛֞֗֙ᭅ ի֌֏֫Ღ֞ᮓ֐֞եշ

DOCUMENT NO. DATE (DD/MM/YYYY) CONSUMER NO.
4126365062 29/07/2022 116232217

֟փ֟᭭ᮝ᭣֑֡ց֒շ֞շ֫փ֊֞֐ն֒֌ֆ֞DISTRIBUTOR CODE, NAME AND ADDRESS

146225, KITCHEN CARE, O T ROAD ULUBERIA NEAR ULUBERIA COLLEGE HOWRAH, WEST BENGAL 711316

շ֊֧᭍֘֊ ֌եվ֠շ֒օ ի֌շ֒օ շ֫փ ֊չ ֒֞֟֘

CONNECTION REGISTRATION EQUIPMENT CODE NOS. AMOUNT
ᮧշ֞֒ ᮰֧օ֠ ᮓ֐֞եշ 82389197 ֚֟ᳲ֔եփ֒ 14.2 SDOM 1 0
TYPE CATEGORY NO. CYLINDER
DOM OTHERS ᳰֈ֊֞եշ 29/07/2022 ֧֒᭏֑֧֡֔ց֒ BPCDPR 1 0
DATE REGULATOR
շ֡֔֒֞֟֘֘᭣ֈ֫֐ᱶ Zero շ֡֔֒֞֟֘ 0
AMOUNT IN WORDS TOTAL
ի֌֏֫Ღ֞շ֞֊֞֐ն֒֌ֆ֞CONSUMER NAME AND ADDRESS
MRS SANHITA MONDAL , SOUMEN GROUND FLOOR BIRSIBPUR BIRSIBPUR HOWRAH West Bengal BIRSIBPUR 711316

֌֡֒֞֊֞᭣֑֫֒֞OLD PARTICULARS ֈ᭭ֆֶ֧֞֗DOCUMENT ᮓ֐֞եշNO. ᳰֈ֊֞եշDATE

֟փ֟᭭ᮝ᭣֑֡ց֒շ֫փ֐֢֔ ձ֚֎֠ց֠֗֠ց֠ձ
DISTRIBUTOR CODE SV/ TV/ TA
ց֧ᳯ֒ց֒֠շ֫փ է֟ֆᳯ֒շֆ֚֟ᳲ֔եփ֒ձ֚֎֠
TERRITORY CODE ADDITIONAL CYLINDER S.V.
ի֌֏֫Ღ֞ᮓ֐֞եշ ձ֚֎֠ց֠֗֠ց֠ձ
CONSUMER NO. SV/ TV/ TA
ֆ֧֔շե֌֊֠
OIL COMPANY
ᳯ֒շ֗֒֠ճ֊էշ֞իեցճ֍ ֔֩᭭ց ֟փ֍֧᭍ց֠֗
RECOVERY ON A/C OF LOST DEFECTIVE
֚֟ᳲ֔եփ֒
CYLINDER
֧֒᭏֑֧֡֔ց֒
REGULATOR
փ֠֎֠ց֠ձ֔է֧փ֗֞ե֚
DBTL ADVANCE
շ֡֔֒֞֟֘
TOTAL AMOUNT
ᮝ֞ե֚֍֒ց֡֟փ֟᭭ᮝ᭣֑֡ց֒շ֞շ֫փ֊֞֐ն֒֌ֆ֞TRANSFER TO DISTRIBUTOR CODE, NAME AND ADDRESS

ᳯց᭡֌օ֠REMARKS :Govt. of India PMUY Cash Asst. of Rs.0.00 (Cyl, Reg, Hose, DGCC, Installn) , Burner Type : Two burner,The
first LPG refill and hot plate has been provided free of cost to you by BPCL

ᳰֈ֊֞եշ ֏֞֒ֆ֌֧ᮝ֑֫֟֔֐շ֩֌ᲃ֧֒֘֊֟֔֟֐ց֧փշ֧᳇֞֒֞֟փ֚ᳯᮝ᭣֑֡ց֒շ֧֛᭭ֆռ֞֒֗ւ᭡֌֞ ᳰֈ֊֞եշ ի֌֏֫Ღ֞շ֧֛᭭ֆռ֞֒

DATE On Behalf of Bharat Petroleum Corporation Limited Distributor's Signature With Stamp DATE CONSUMER SIGNATURE

ᳯց᭡֌օ֠շ֣֌֑֞ᮧ֐֞օ֌ᮢֆև֞֐֡᭎֑֟֊ֈᱷ֘ᲂշ֧֟֔ձ֟֌ս֔֞ᮧ᭭ֆֈᱶո֧NOTE : For certification and important Instruction please see overleaf.

Digitally signed by DS Bharat Petroleum
Corporation Limited
Date: 2023.12.12 14:00:22 +05:30