Application to update Personal Details

(To be submitted with photocopies of self-attested Pan Card / Driving License / Passport &
PostPaid Bill (if applicable) or other relevant documentary proofs)

Date :

Distributor Name :

District :

Sub: Request to update E-mail ID/Mobile Number

Name of Consumer : …………………………………………………………………

Consumer Number :

LPG ID : 2

Updation of New Email ID Mobile No

Dear Sirs,

Please update my Personal Details as mentioned below. I agree, that all notifications / Alerts will be
sent to the registered Mobile/E-mail for all the transactions /changes done for this LPG Account.

New Mobile Number : ………………………………………………..

New E-mail address : …………………………………………………………………………………………………………………….

Signature of Consumer : ……………………………………… Date: ………………….

Note - An alert on the status of your request would be sent on your E-mail id / Mobile No if any
………………………………………………………………………………………………………………………………………………………

Customer Acknowledgement Slip (To be filled by Distributor/Staff) Date : ………………………..

Received from ………………………………. Consumer No (or) LPG Id………………………………………………………

I hereby acknowledge the receipt of request for updation of Mobile No / Email Id

Distributor Name : ………………………………………………………………………………

Distributor/Staff Signature : …………………………………………… Date : ………………………

Distributor Seal