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    KYC - Bharatgas

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    surent
    This document contains a Know Your Customer (KYC) form for a Bharatgas consumer. It includes personal information such as name, date of birth, address, contact details, identification documentation, and a declaration signed by the consumer and distributor. The form collects details to verify the customer's identity and address as required by KYC regulations to establish an LPG connection.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    KYC - Bharatgas

    Uploaded by

    surent
    534 views3 pages
    This document contains a Know Your Customer (KYC) form for a Bharatgas consumer. It includes personal information such as name, date of birth, address, contact details, identification documentation, and a declaration signed by the consumer and distributor. The form collects details to verify the customer's identity and address as required by KYC regulations to establish an LPG connection.

    Original Description:

    KYC Norms for Bharat Gas booking

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    © Attribution Non-Commercial (BY-NC)

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    This document contains a Know Your Customer (KYC) form for a Bharatgas consumer. It includes personal information such as name, date of birth, address, contact details, identification documentation, and a declaration signed by the consumer and distributor. The form collects details to verify the customer's identity and address as required by KYC regulations to establish an LPG connection.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    534 views3 pages

    KYC - Bharatgas

    Uploaded by

    surent
    This document contains a Know Your Customer (KYC) form for a Bharatgas consumer. It includes personal information such as name, date of birth, address, contact details, identification documentation, and a declaration signed by the consumer and distributor. The form collects details to verify the customer's identity and address as required by KYC regulations to establish an LPG connection.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    4/11/13

    KYC - Bharatgas

    CONSUMER INFORMATION SHEET (Wait list ID: 3416814) Name of Distributorship: Name Of Consumer* Salutation (Mr./Ms./Mrs/Miss)*: First Name*: Middle Name: Last Name*: Consumer Number: Date Of Birth*: Father's Name*: Mother's Name: Name Of Spouse: S (Name to be entered as per Photo ID Proof) (Only for existing customers) 11-06-1965 DD-MM-YYYY SOLOMONRAJ MARY COROLINE VIMALA MR. REX

    Address* (Address to be written as given in Proof of Address) House No*: House Name/Flat Floor No*: Housing Complex/Building No*: Street/Road Name*: Area/Land Mark: City/Town/Village*: District*: State*: PIN Code*: Telephone Number: Mobile Number: Email ID: * Mandatory Fields
    At least one of the following documents of Proof of Address is mandatory. Kindly tick the document provided for Proof of Address . Aadhaar (UID) letter . Lease agreement / rent receipt . Telephone/Electricity or any other utility bill . Self-declaration attested by Gazetted officer . Flat allotment/possession letter . LIC Policy . Driving License . Voter ID At least one of the following documents of Proof of Identity is mandatory. Kindly tick the document provided for Proof of Identity . PAN Card . Passport . Voter ID . Aadhaar (UID) letter . Driving License . Central/State Government Issued ID Cards . . -

    5B/2 ARJUN NAGAR , KOLATHUR CHENNAI-99 CHENNAI, T.N. Tamil Nadu 600099 9840310708

    www.ebharatgas.com/ebgas/faces/KYC_Print.jsp?p1=3416814&p2=11-06-1965&p3=MARY COROLINE

    1/3

    4/11/13

    KYC - Bharatgas

    . Passport . Ration Card . House registration document

    . . . -

    CONSUMER INFORMATION SHEET (Page 2) Do you have Pan Number: Yes If Yes, Please enter PAN Number: Do you have a Passport: No If Yes, Please enter Passport Number: Do you have a Driving License: Yes If Yes, Please enter Driving License No: Do you have a Ration Card : Yes If Yes, Please enter Ration Card No: Do you have UIDAI Aadhaar No: No If Yes, Please enter your Aadhaar No: Do you have Voter ID (EPIC-Election Photo ID Card): Yes If Yes, Please enter your Voter ID No: If Yes, Please enter your ID No: Other Address Proof: Optional Details Bank Name: Branch: Address: IFSC Code: Account Number: Declaration: I declare that the information provided by me on the above form is true and correct to the best of my knowledge and belief. I also confirm that in the event of any information provided by me is not true and incomplete and also in the event of any violation of Government Regulation related to the supply and distribution of LPG, BPCL will be well within its right to take necessary action including discontinuation of supply of LPG cylinders, can forfeit the security deposit and can levy penal charges as per the policy and guidelines. I am willing/not willing to avail the Subsidy on LPG cylinders therefore I have provided/not provided my Bank account details on the above request form. I also confirm that I do not have any objection in receiving SMS from BPCL on the mobile number given in this form. Signature of Customer*: Signature of Distributor*: Date: Date: AZZ3293347 Yes No Yes No Do you have Id (Issued By Central State Government): No F/TN/002/011118/ 01/G/0628573 ARTPR5903R Physically Verified by Distributor? Yes No Yes No Yes No Yes No Yes No

    -------------------------------------------------Tear Off---------------------------------------------I/We, hereby, confirm receipt of duly filled in KYC form along with relevant documents of Proof of Identity and Proof of Address has been received
    www.ebharatgas.com/ebgas/faces/KYC_Print.jsp?p1=3416814&p2=11-06-1965&p3=MARY COROLINE 2/3

    4/11/13

    KYC - Bharatgas

    from ----------------------------------------- on---------------- (date)

    Signature and Seal of Distributor

    www.ebharatgas.com/ebgas/faces/KYC_Print.jsp?p1=3416814&p2=11-06-1965&p3=MARY COROLINE

    3/3

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