MAHANAGAR GAS LTD.

MGL House, G-33 Bandra Kurla Complex, Bandra (East), Mumbai - 400 051. CUSTOMER COPY
Customer care # 68674500 /61564500. Website : www.mahanagargas.com WG/M/100362/2024

APPLICATION FORM-CUM-RECEIPT FOR SUPPLY OF PIPED NATURAL GAS (PNG) FULL PAYMENT SCHEME

PERSONAL DETAILS (TO BE FILLED IN BLOCK LETTERS ONLY)

Mr./ Mrs./ Miss./ M/s./ Dr.* FULL NAME (AS PER ID SUBMITTED)
Mrs. MONOMITA ROY

INSTALLATION ADDRESS (TO BE FILLED IN BLOCK LETTERS ONLY)

FLAT / ROOM NO* FLOOR WING PLOT NO SECTOR NO BUILDING NAME / NUMBER *
705 7 A 19/ 14 INTELLIGENTIA SPECTRUM-A

SOCIETY NAME AREA / LOCATION * PINCODE *

INTELLIGENTIA SPECTRUM-A-HAWARE CITI G. B. ROAD/KASARVADAVALI 400615

E-MAIL ID MOBILE NO*

roymonomita2@gmail.com 9342211286

I AM OWNER & OCCUPIER ✓ MY PREMISES IS GIVEN ON RENT I AM TENANT ALTERNATE NO

✓ I declare that my premises is given on Rent. I will inform MGL if I start using PNG for myself. * MANDATORY FIELD

ADDRESS & IDENTITY PROOF (TO BE ENCLOSED) PAYMENT DETAILS (NO CASH PAYMENT ACCEPTED)

PROOF OF IDENTITY
(Please tick any one)(✓)
# ✓ Adhar Card # Voter Id / Passport TYPE OF PAYMENT
✓ ONLINE / UPI CHEQUE

# Driving License Pan Card CHEQUE / TXN ID ZHD1JYF056M4N6

BANK NAME
✓
PROOF OF Government ID like (#) Society Document (Share
ADDRESS with above installation Certificate / Letter /
address Maintainence Bill), etc. DATE / AMOUNT 13-11-2024 6385
(Please tick any one)
(✓) Sale Deed / Lease deed House Tax Receipt/ Electricity Bill Please pay by Cheque / DD In Favour Of “Mahanagar Gas Ltd.” Cheque subject to realisation
Agreement to sale, etc. / Company letter
RTGS / NEFT DETAILS - Name: MAHANAGAR GAS LTD IFSC: YESB 0000 001
If ID proof (#) is with above installation address, only one proof will suffice for ‘identity’ & ‘address’. Account Number: 1814 0000 5803 Bank Name & Branch: YES Bank. Worli, Mumbai- 400018

DO YOU HAVE A LPG CONNECTION

IN YOUR NAME? ✓ Yes No AMOUNT TO BE PAID WITH APPLICATION FORM

LPG CONSUMER NO. 673833 ₹ 750/- Non Refundable Application Charges.

₹ 4500/- Interest Free Refundable Security Deposit for Gas Connection*
Indane Bharat Gas

✓
₹ 1000/- Interest Free Refundable Security Deposit for Gas Consumption
If yes tick(✓)
HP Gas Other ₹ 135/- GST @18% of Application Charges.
SCAN HERE
LPG DISTRIBUTOR NAME MANRATH ENTERPRISES, BANGALORE ₹ 6385/- Total Amount FOR PAYMENT
*The total Security Deposit for Gas connection is ₹ 5000.
₹ 4500/- is collected with Application Form & balance ₹ 500/- in first bill.

DECLARATION BY APPLICANT

1. I/We declare the above details are true & correct and authorize MGL to verify the same. 2. I/ We acknowledge that we will visit
NAME www.mahanagargas.com for latest terms and conditions which shall be binding on me/us. 3. I/We agree that this application
can be accepted or rejected by Mahanagar Gas Ltd., without assigning any reason thereof. 4. I/We agree to surrender the LPG
Connection within 60 days of activation of PNG Connection OR keep the LPG Connection in safe Custody.

✓I have received a copy of application form ✓I want to go green and opt for paperless billing. APPLICANT SIGNATURE

Date / / Name MONOMITA ROY

NOTE:
1. For any details/ queries, please call us on Customer Care. 2. Application Charges will be refundable in case premises is found "TECHNICALLY NOT FEASIBLE" by MGL. 3. Any other charges shall be
charged as per the standard Rate card which is available on website "www.mahanagargas.com" 4. Anybody demanding cash or extra charge must be brought to the notice of Vigilance Dept. via mail at
vigilance@mahanagargas.com. 5.Incomplete Application Form will not be accepted 6. MGL bill is not proof of ownership of the Property.

FOR OFFICE USE

BP No. CO No. AGENCY CODE

APPLICATION NO WG/M/100362/2024 AGENCY NAME

RECEIVED DATE SR. NAME

SPECIAL COMMENTS
IF ANY: SIGNATURE of DMA
C H E C K E D B Y - M I C
TERMS AND CONDITIONS FOR SUPPLY OF PNG
(I) Consumer fails to pay MGL any sum due to MGL under these Terms and Conditions; or
1.0 DEFINITIONS: (ii) Consumer fails to comply with any of its obligations and/or commits any breach of the conditions
“Application” means duly filled Application Form Cum Receipt submitted by Consumer along with the
on his part to be observed, performed, or fulfilled; or
(iii) The particulars as furnished by Consumer in the Application are found to be false or incorrect.
applicable charges for taking PNG connection.
“Consumer” means the person/ entity who has taken PNG connection in his name.
(iv) PNG is not consumed by the Consumer for a continuous period of 26 weeks or more and no
“MGL” means Mahanagar Gas Limited.
minimum charges is also being paid by the Consumer.
'MGL Assets' means pipelines, meter, regulator and other equipment's installed for supply of PNG.
(v) Consumer fails to surrender subsidized Liquified Petroleum Gas (LPG) connection obtained from
“Premises” means the house / flat owned / occupied by Consumer where PNG is supplied / is
Government Oil Company within sixty days of obtaining PNG connection from the MGL.
8.2 In case of termination under clause 8.1 MGL shall have the right to remove its MGL Assets from
sought.
“PNG Rate Card” means schedule of charges for different items/ services payable by Consumer as
the premises of the Consumer and the Consumer here by undertakes not create any obstruction
mentioned on the MGL Website: www.mahanagargas.com during such removal of assets by MGL.
8.3 Temporary Disconnection:
2.0 PNG CONNECTION AND SUPPLY: In case of any planned non usage of PNG for a continuous period of 26 weeks or more, Consumer
2.1 PNG will be made available in the Premises, in accordance with the technical and safety shall intimate MGL about such non usage. In such cases, MGL shall temporarily disconnection of
standards as specified by MGL, and subject to the availability of all requisite permissions. PNG supply. To resume the gas supply, Consumer shall approach MGL and upon payment of
2.2 MGL shall endeavor to provide PNG connection at the earliest date from the receipt of reconnection charges, the PNG supply shall be resumed.
Application. However, MGL shall not be responsible for any delay in providing PNG connection for the 8.4 Permanent Disconnection :
reasons and circumstances beyond MGL's control . Consumer may, by written notice seek permanent disconnection of his PNG connection and in
2.3 MGL reserves the right to withdraw or disconnect the supply of PNG at any time in the event of suchcase, Consumer shall be liable to pay all dues till the date of permanent disconnection.
any emergency/ technical snag without any notice. 9.0 RECONNECTION :
3.0 USE OF PNG: 9.1 In the event of stoppage of PNG supply/ temporary disconnection, reconnection shall be done
3.1 Consumer shall: only upon payment of reconnection charges applicable as per PNG Rate Card.
(I) use PNG specifically for permitted domestic (cooking) purpose, only at the Premises and not for 9.2 In the event of permanent disconnection (wherein all the MGL Assets are removed by MGL from
any other purposes. the Premises) on account of default on part of Consumer or at the written request of Consumer ,
(ii) obtain specific prior written permission of MGL for any change in use of PNG at the Premises. PNG connection shall be provided upon filing of fresh Application.
(iii) install any equipment's like geysers etc. only through MGL authorized representative. 10.0 SHIFTING OF RESIDENCE :
4.0 CHARGES: If a Consumer desires to shift from the present place of residence having a PNG connection to a new
4.1 MGL at its discretion may revise / modify the applicable charges as mentioned in PNG Rate Card place of residence, the existing PNG connection will not be transferred to the new place of residence.
available at the Website (www.mahanagargas.com) and shall be binding on Consumer. However, Consumer can apply for fresh connection for the new place of residence.
5.0 BILLING AND PAYMENT: 11.0 TRANSFER OF CONNECTION:

5.1 Every bill shall be paid by Consumer in full on or before its due date mentioned on the bill. In the 11.1 MGL may permit transfer of PNG connection in the event of sale/purchase of the Property,
event of delay in making payment of any amount due to MGL, the Delay Payment Charges (DPCs) demise of Consumer etc. subject to submission of necessary documents as required by MGL and on
along with interest shall be levied in the bill. payment name transfer charges. The transfer will be effective from the date of written confirmation
5.2 If the Consumer is making the payment of bill via cheque or DD, Consumer shall make the by MGL. In case of transfer of PNG connection to the legal heir of Consumer upon the demise of
payment atleast three days before the due date to avoid levy of any delayed payment charges. Consumer, no transfer charges are payable.
5.3 In case of non-availability of actual meter reading, MGL will raise bills on past average 11.2 Purchaser of a flat/ house with pre-existing MGL's PNG connection, shall be liable for the
consumption. The amount paid by the Consumer against such bills shall be adjusted in the bills payment of past dues if not settled by the seller. MGL shall not supply PNG in such cases without
raised on actual meter readings as and when such readings are taken. settlement of past dues.
5.4 If meter is inaccessible on three consecutive billing cycles a seven days' notice shall be served 12.0. LIABILITY / INDEMNITY:
on Consumer to keep the Premises available for meter reading on the date and time indicated in the
notice. In case Consumer fails to comply with the notice, MGL reserves the right to disconnect the 12.1 Consumer shall not use PNG for any illegal or unlawful activity or purpose. In case of any
PNG supply of the Consumer. offence / violation of any law, statute or regulation by Consumer, Consumer alone shall be
responsible and liable for such offence or violation and Consumer agrees to indemnify and keep
5.5 In case of any dispute or any discrepancy with respect to consumption /amount of bill, Consumer
is required to lodge his complaint within 14 days of making the payment and on receipt of such indemnified MGL from and against any loss, claim, action or proceedings that may be suffered or
complaint, MGL will look into the issue and if found correct, will make necessary adjustments in the incurred by the MGL as a result of such offence or violation.
subsequent bills. 12.2 Consumer shall ensure that PNG provided by MGL is exclusively used for domestic (cooking)
5.6 Consumer shall ensure to make the payment of bill in the mode and manner as mentioned in the purpose. If at any time after the commissioning, it is found that PNG is being used for other than
domestic purposes, Consumer shall be liable to pay all the bills with an additional penal rate as
bill,-MGL shall not be responsible for any payment made by the Consumer in any other mode or
manner other than what is mentioned in the bill. specified by MGL, with retrospective effect from date of connection.
5.7 If gas consumption goes over and above the security deposit (gas consumption) then the same 12.3 Consumer shall be liable for payment of any loss or damage caused to pipes, equipment or
installations whether caused on account of negligence by Consumer or its employees or agents,
shall be revised periodically and will be mentioned in subsequent bills.
5.8 MGL shall not be responsible for any payments made by the Consumer to any other agency/ theft, sabotage or otherwise, howsoever.
12.4 Consumer shall indemnify and keep MGL indemnified from and against any action, claim,
person other than the one authorised by MGL.
proceeding, loss or damage that may be suffered or incurred by MGL on account of any dispute with
6.0 OBLIGATlON'S OF CONSUMER: the Landlord/Society or consumer failing to obtain the permission of the Landlord/Society for laying
6.1 Consumer shall permit MGL/ its authorized representative access to the Premises for providing of pipelines, equipment and other installations for PNG supply and in case of any event as aforesaid,
PNG connection, meter reading, inspection, maintenance checkups, alteration or replacement of any Consumer shall pay to MGL all costs for removal of the pipelines, equipment and other installation
MGL Assets (if deemed necessary or expedient by MGL) and disconnection. for PNG supply.
6.2 Consumer shall take all adequate precautions and adopt all safety measures to safeguard MGL 12.5 Consumer shall deem to be in exclusive possession and control of PNG once PNG passes the
Assets installed by MGL at Consumer's Premises for supply of PNG. Consumer shall not adjust, meter outlet, and there upon Consumer shall be liable for any leakage or for any damage caused to
clean, repair, replace or otherwise handle any of the MGL Assets. If any damage / breakage / any person or property as a result thereof. Accordingly, Consumer shall protect and indemnify and
nonfunctioning of the MGL Assets is noticed, Consumer shall immediately intimate to MGL and MGL keep harmless and defended MGL against all claims, demands actions, suits, proceedings,
shall replace or rectify the same at the earliest on chargeable basis, if damage is due to Consumer's judgments and all liabilities, costs, expenses, damages or losses which may arise out of or result
negligence. from or which the MGL may incur or suffer as incidental to or in connection with the supply of PNG
6.3 In case, Consumer carries out any unauthorized repair/ alteration or tamper/permits tempering, after PNG passes the meter outlet or during temporary disconnection, if any.
directly or indirectly, [Jointly or severally referred to as Illegal Acts] of any MGL Assets for PNG 12.6 The indemnity provisions will be enforceable notwithstanding termination of PNG supply.
supply, the same shall be deemed to be breach of the contractual terms contained herein and, in 12.7 MGL shall not be liable for consequential loss (being loss of business, goodwill, opportunity or
such cases, MGL reserves the right to terminate the Agreement and remove its Assets from the profit)
Premises & forfeit the security deposit. Further, in case of any accident/ incident, due to Illegal Acts 13.0 FORCE MAJEURE :
in relation to MGL Assets, Consumer shall be solely responsible for any loss or damages or to the
MGL shall be excused from performance and shall not be in default in respect of any obligation
property or human life arising out of such accident. MGL shall not be responsible for any direct or
indirect loss caused on account of any such illegal Act by Consumer hereunder to the extent that the failure to perform such obligation is due to acts of god, war, revolt,
6.4 Consumer shall notify MGL in case of non-receipt of riot, fire, tempest, flood, earthquake, lightning, pandemic, direct or indirect consequences of
(I) first PNG bill within the period of two months from the date of commencement of PNG supply; (declared/undeclared) sabotage, hostilities, national emergencies, civil disturbances, commotion,
(ii) periodic PNG bills within 10 days from the expiry of two months period of receipt of the previous embargo or any other change in applicable laws, breakage bursting or freezing of pipeline or
occurrence of any event beyond the control of MGL.
bill. In case of non-receipt of PNG bill, Consumer shall obtain duplicate copy of PNG bill and make
the payment of the same within the due date. 14.0 AMENDMENT :
6.5 Consumer shall inform in writing to MGL before any change of ownership of the Premises and
MGL reserves its right to amend, add or delete all or any of these terms and conditions at any time
clear all pending arrears/ dues before submitting written request to MGL for refund of Security including right to amend due to change in applicable laws. As and when such amendment is
Deposit. affected, the same shall be uploaded on the web site of MGL and shall be binding on Consumer from
6.6 In case if there is any change in the registered mobile number of Consumer, Consumer shall the date of its uploading on the website including amendments due to change in law.
update the same to MGL on immediate basis.
15.0 NOTICE
7.0 PROPERTY/OWNERSHIP:
All notices, demands or other communications issued by MGL shall be sent to Consumer as per the
MGL Assets up to and including Suraksha hose pipe connecting the burner shall be and remain the
address provided by Consumer on the Application.
property of MGL and Consumer shall not have or claim any right, title or interest therein.
16.0 JURISDICTION :
8.0 TERMINATION
8.1 Without prejudice to above & other rights of MGL in law or otherwise, MGL may at any time and All disputes arising out of these Terms and Conditions, shall be subject to exclusive jurisdiction of
with prior notice terminate PNG supply of Consumer if: Competent Courts at Mumbai

17.0 CONFIDENTIALITY

Information provided to MGL by Consumer shall be used for the purposes enumerated in this terms
& conditions and shall be kept confidential unless the same is required to be disclosed (i) for billing
or market operation purposes, or (ii) for law enforcement purposes, or (iii) dues if any of Consumer is
transferred to debt collection agency; and in such cases the confidentiality obligations shall cease to
the extent required under the foregoing circumstances.

((Applicant Signature))