ANNEXURE - II
Mechanics Pre-Installation check of Customers Premises for LPG connection
Date:
Name and Address of the Distributor:
Consumer Name:
Address:
Mobile No:
Consumer’s KYC No:
I, , have on date visited the customers premises at
the above-mentioned address and have carried out the following Inspections.
1) Whether the Applicant stays at the address provided by the applicant and
Is correct as per his declaration YES / NO
2) The Household has an LPG connection of any OMC YES / NO
3) Whether the Applicant has a separate Kitchen YES / NO
4) Whether the Kitchen is safe for LPG Installation? That is roof and walls are
Not of flammable material YES / NO
5) Whether the Kitchen has a Platform for placing LPG Stove YES / NO
Signature / LTI of Applicant Name and Signature of Mechanic