Existing User Information
Name :
Current Outstanding Amount :
Note : Current outstanding amount to be cleared for successful Name Transfer.
Please note * fields are mandatory.
New Customer Information
Customer Name Initial* :
Customer First Name* :
Customer Middle Name :
Customer Surname* :
Father/Husband's Name :
Date of Birth* :
Occupation :
Contact Information
PAN No.* :
Mobile No.* :
Telephone No.(Residence) :
Telephone No.(Office) :
Email ID* :
Details of Meter installed at premise
Meter No.* :
Meter Reading* :
Do you have LPG gas connection in your name ?* :
Gas Supplier :
Gas Distributor :
LPG Connection Number :
Reason for Transfer of PNG Connection* :
Documents required*
Note: Agreement pages referring to pervious and current owner name along with address to be uploaded.
Note: Attach previous owner's PAN card with NOC, while uploading NOC.
Name Changes id being processed for following address
BP No. :
CA No. :
Address
Flat/Room No :
Floor :
Wing :
Plot No :
Building Name :
Colony Name :
Road Name :
Location :
Land Mark :
City :
Pincode :
Enter Captcha* :