How to Get Free LPG Connection for BPL Families

Ujjwala KYC Application

(To be filled in BLOCK LETTERS only. All fields are mandatory.)

Consumer details

a) Name of applicant Ms. / Mrs. <This scheme is only available to women applicants who are below the poverty line.

1. First Name: <Write your middle name here, as it appears on the official ID proof being submitted. Remember to fill all details in BLOCK LETTERS ONLY.>
2. Middle Name: <Write your middle name here, as it appears on the official ID proof being submitted. Remember to fill all details in BLOCK LETTERS ONLY.>
3. Last Name: <Write your last name here, as it appears on the official ID proof being submitted. Remember to fill all details in BLOCK LETTERS ONLY.>

Date of Birth: <Write your date of birth here, in the DD/MM/YY format.>

b) Address for LPG Connection/Contact information

1. Proof of Address (POA) Category Code: POA _ _ <Here, fill out the category code associated with the exact document being submitted as proof of address. A list of category codes is available below.>Land line number with STD code: <Here, fill out the land line phone number, if any.>
2. House/Flat number and name: <Here, enter the name of the house/flat along with the house/flat number.>Floor Number: <Enter the floor on which the residence is located.>
3. Housing Complex/Building: <Enter the name of the housing complex or building name, if applicable.>Landmark: <Here, enter the name or details of any nearby landmark which can be used to identify the location of the building.>
4. Street/Road Name: <Enter the name of the street or road on which the residence is located.>Area/Post office name: <Write details of the nearest post office servicing the area, or the name of the area as defined in official planning records available at the local authority.>
5. City/Town: <Enter the name of the city or town under whose local administrative body the residence is registered.>PIN Code: <Write the correct PIN Code of the registered address.>
6. Village/Panchayat: <If the residence is registered under a village/panchayat enter those details here.>Mobile number: <Enter your 10 digit mobile phone number here.>
7. Block/sub district: <Write the name of the block or sub district here, if applicable.>Email ID: <Enter your personal email ID here, if applicable.>
8. District: <Enter the name of the district, if applicable.>
9. State: <Write the name of the state in which the residence is located and the subsidy is being sought.>

c) Details of household members aged above 18 years (consisting of people living together in a dwelling unit having a common kitchen)

PAHAL Scheme Joining Details

d) Particulars of my Aadhaar Card (Attach Copy of Aadhaar Card)

1. Name in Aadhaar Card: <Enter the name as it appears on the Aadhaar Card.>
2. Aadhaar Number: <Enter the Aadhaar number here.>

e) Particulars of My Bank Account (Attach Copy of Passbook/Bank statement/cancelled cheque bearing account holder’s name, account number and IFSC code)

1. Name in bank account: <Enter the name as it appears on the official bank records, it’s alright if the spelling, etc. doesn’t match, as the official spelling as per Aadhaar records is also mentioned.>
2. Bank name: <Write the name of the bank in which the account is held.>
3. Branch name: <Write the name of the bank branch in which the account is held.>
4. IFSC Code: <Write the IFSC code of the bank branch here. You can find all IFSC codes 
5. Bank account number: <Write the correct bank account number here.>

Ration Card Details (Attach a Copy of Ration Card)

1. State of issue: <Enter the name of the state in which the ration card was issued, not the current state of residence.>
2. Ration card number: <Enter the correct ration card number that appears on the card.>

1. Type of LPG cylinder desired:

<Here, tick the box against which cylinder is required.>

2. Do you need LPG stove from distributor:

<Here, tick either ‘yes’ or ‘no’ depending on whether you want an LPG stove from the distributor.>

3. Do you need a loan from OMCs for LPG stove and first LPG refill:

<Here, tick whichever box(es) are required. If you tick ‘Stove’ and ‘Refill’ you will be applying for a loan from the OMCs for the same.>

Dear LPG Distributor,

I __<write your name here> son/daughter/wife of __<strike out the irrelevant options and write the name of the relation here> aged __<write your age here> years, resident of __<write your address here> desire to take desire to take a domestic LPG connection in my name and affirm as under:

1. I hereby confirm that the information furnished in this form is correct and nothing material has been concealed therefrom and I understand that false information, if any, will attract punishment under the Indian Penal Code (IPC).
2. I shall not hold IOC/HPC/BPC/MoP&NG responsible for any delays/non receipt of subsidy in case of change/closure/deactivation of my Bank Account/Bank not in NACH or for any rejection by Bank or non-confidentiality of any information.
3. In case of any revision/change in the above information, I will inform the LPG Distributor.
4. I authorize my Oil Company/bank to update/share my Aadhaar No./demographic data/bank account details between themselves and with outside agencies for de-duplication/authentication/verification purposes.
5. In case LPG stove and first refill is purchased on loan from OMC, I authorize my OMC to recover the loan amount from the subsidy of refills availed by me. I am fully aware that I will not receive the subsidy amount of the refills purchased by me in my bank a/c till the time the loan amount is fully recovered by the OMC.
6. In the event of any violation of Government Regulation related to the supply and distribution of LPG, IOC/BPC/HPC will be within its right to discontinue supply of LPG cylinders to me, forfeit of security deposit and levy of penal charges as per the policy and guidelines and may initiate legal action applicable under provisions.
7. That I am an Indian Citizen/Non-Resident Indian/Staff of Foreign nationality serving in India/Foreign national residing in India under valid Visa/person returning to India on transfer of residence basis/PIO *Tick whichever is applicable. Only Indian citizens are eligible for subsidized LPG.
8. That my date of birth is __ <write your date of birth here>
9. That neither I, nor any other member of the household (household means a family consisting of husband, wife, unmarried children and dependent parents living together in a dwelling unit having a common kitchen) possess any LPG connection from PSU Oil Companies or Piped Natural Gas Connection for domestic use in our dwelling unit. (Households having Piped Natural Gas subsidy are not entitled for subsidized LPG.)
10. I confirm that the LPG connection issued to me will be used in my above mentioned address and for domestic cooking purposes only, and I shall abide by all governing terms.
11. That I shall not position any other LPG gas installations in the same kitchen.
12. That as and when a second cylinder is issued to me against this connection, the same will also be used in the same kitchen and with the original installation.
13. That whenever I change my residence from the present address to another, I will inform M/s __ <write the name of your LPG distributor/RGGLV here> in writing in advance for the change of address in the records.
14. That I am aware that the domestic subsidized LPG connection as shall be released by IOC/BPC/HPCL on the basis of this declaration and information submitted by me in this KYC from, POA, and POI, shall later be subjected to de-duplication check for existence of any other Domestic subsidized LPG connection with any govt. Oil Company, in my name or in the name of any other member of my household.
15. That if any information/declaration given by me in this undertaking, the KYC form or any document submitted in support of identity/residence proof shall be found untrue or incorrect or false, the Oil Company would be within its rights to withdraw the supply of Gas/Terminate the connection/seize the equipment/forfeit the security deposit and that I would have no claim whatsoever against IOCL/BPCL/HPCL for such withdrawal/termination/seizure/forfeiture.

Date: <Write the date on which you filled the form here>

Place: <Write the place in which the document was signed here>

Signature of the person giving the declaration

Name: <Write your name here and affix your signature next to it.>