Annexure – II Pradhan Mantri Garib Kalyan Package Declaration by PMUY Consumer Confirmation of Refill Delivery I, undersigned …………………………………………… son/daughter/wife/husband of ………………………… Age ……. Years residing at ………………………………………………… do hereby solemnly affirm and confirm that we have received LPG refill under Pradhan Mantri Garib Kalyan Package for our connection under Pradhan Mantri Ujjwala Yojna for consumer number _______________ from LPG Distributor of BPCL/HPCL/IOC M/s. __________________________________ located at _______________________ on date _______ . The delivery of refill has been accounted for in my DGCC and I have paid the amount of refill to the person delivering the refill. Signature of the customer Date : Place : Annexure – II Pradhan Mantri Garib Kalyan Package Declaration by PMUY Consumer Confirmation of Refill Delivery I, undersigned …………………………………………… son/daughter/wife/husband of ………………………… Age ……. Years residing at ………………………………………………… do hereby solemnly affirm and confirm that we have received LPG refill under Pradhan Mantri Garib Kalyan Package for our connection under Pradhan Mantri Ujjwala Yojna for consumer number _______________ from LPG Distributor of BPCL/HPCL/IOC M/s. __________________________________ located at _______________________ on date _______ . The delivery of refill has been accounted for in my DGCC and I have paid the amount of refill to the person delivering the refill. Signature of the customer Date : Place : Annexure I Pradhan Mantri Garib Kalyan Package Declaration by PMUY Consumer Request for Counter Booking I, undersigned, …………………………………………… Daughter / Wife of ………………………… Age ……. Years residing at ………………………………………………… do hereby solemnly affirm and say as under : 1. That I am a resident of the above specified address. . 2. That I have availed connection under Pradhan Mantri Ujjwala Yojna in my name from LPG Distributor of BPCL/HPCL/IOC M/s. _________________________________located at__ ______________________ and my consumer number is ____________________ 3. That other than me, there are ___ members in my family who reside with me at the above specified address. 4. That neither I nor any member of my family am/is in possession of a working Mobile number/phone. Therefore cannot to do refill booing from registered mobile number 5. View above, I am requesting you to do counter refill booking for me. Signature of the customer Date : Place : Annexure I Pradhan Mantri Garib Kalyan Package Declaration by PMUY Consumer Request for Counter Booking I, undersigned, …………………………………………… Daughter / Wife of ………………………… Age ……. Years residing at ………………………………………………… do hereby solemnly affirm and say as under : 1. That I am a resident of the above specified address. . 2. That I have availed connection under Pradhan Mantri Ujjwala Yojna in my name from LPG Distributor of BPCL/HPCL/IOC M/s. _________________________________located at__ ______________________ and my consumer number is ____________________ 3. That other than me, there are ___ members in my family who reside with me at the above specified address. 4. That neither I nor any member of my family am/is in possession of a working Mobile number/phone. Therefore cannot to do refill booing from registered mobile number 5. View above, I am requesting you to do counter refill booking for me. Signature of the customer Date : Place : Annexure IV Pradhan Mantri Garib Kalyan Package Declaration by PMUY Consumer Request for Change in Mobile number I, undersigned …………………………………………… Daughter / Wife of ………………………… Age ……. Years residing at ………………………………………………… do hereby solemnly affirm and say as under : 5. That I am a resident of the above specified address. . 6. That I have availed connection under Pradhan Mantri Ujjwala Yojna in my name from LPG Distributor of BPCL/HPCL/IOC M/s. __________________________________ located at __________________________________ and my consumer number is ____________________ 7. That other than me, there are ___ members in my family who reside with me at the above specified address. 8. I wish to update the mobile number for registering against my LPG connection. f. My existing mobile number is ; g. this number is in the name of h. My new mobile number is i. This number is in the name of and j. My relation with this person is I also declare that the new number is not linked to any other LPG connection. Signature of the customer Date : Place : Document attached – Aadhaar of Consumer