Appendix- P1A
Details of land offered by the Applicant for LPG Godown/LPG Showroom
Type of LPG Distributorship : Sheheri/Rurban/Gramin Vitrak / Durgam Kshetriya Vitrak
Name of Location __________________________ Category________________
Name of District __________________________
Date of advertisement _____________
Name of Applicant (Sh/Smt/Kumari) :
Site Address along with the Survey/Gatta No./Khasra No. (As mentioned in the application form or
alternate site offered at the time of FVC):
Landmark details with description of all boundaries of the Site (for clear identification purpose).
I hereby confirm that the above mentioned details of the plot offered by me are correct and the same
site has been inspected by the Company Officials as mentioned below. I also understand that in case
any of the details mentioned above are found incorrect or the site is found unsuitable by the Corporation
for any reason whatsoever then I would have no claim on this Regular distributorship location.
Signature of the applicant /Authorized Representative of applicant
(Name of the applicant/authorized representative )
Date :
FVC Committee Member
(Name & Signature)
Date :
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Appendix - P1B
Format of Undertaking to be given by the candidate for Approach Road to the Godown /
Godown land at the time of Field Verification of Credentials (FVC)
(On Non Judicial Stamp Paper of required value duly Notarized)
I,____________________son/daughter/wife of ___________________, residing at _____________,
have been selected in the draw for appointment of Regular Distributorship of IOC*/BPC*/HPC* at
______________ newspaper dated_________
I hereby undertake the following:
I am aware that I have to provide an all-weather motorable approach road connecting to the
land for godown/ godown offered by me, for unhindered movement of LPG cylinder truck
for running the business of LPG distributorship.
I hereby confirm that I shall make available the approach road to the said land for godown/
godown as per the eligibility requirement of the advertisement within a period of 4 months
from the date of issuance of Letter of Intent (LOI)
I am aware that for any reason, if I do not qualify for issuance of LOI, this undertaking would become
null and void.
I am also aware that in case I fail to provide an all-weather motorable approach road as per the
eligibility requirement of the said advertisement within the time frame as provided in the LOI, my
allotment for the LPG distributorship should be cancelled along with forfeiture of Rs _____ deposited
before conducting the FVC.
I also wish to confirm that I should not hold the Corporation liable in any form for the consequences
of rejection of my candidature due to my inability to provide an all-weather motorable approach road
as per the conditions specified above.
That this Affidavit cum undertaking is being issued by me on my own volition.
Deponent
Verification
Verified that the contents given above in the aforementioned undertaking are correct to best of my
knowledge and belief. No part of it is false and nothing stated herein has been misstated or concealed.
Deponent
Place :
Date :
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Applicable from 18.08.2023
