For office use only

Form No ……………………………….
Business partner no.: ……………..
Date of Receipt of Registration: ............

Dewas office: A-7, 1st Floor, Gangotri Complex, A-B Road, Dewas, MP-455001 Phone: 07272-250878, 07272-250879

Corporate Office: A-1, Sector-2, NOIDA, UP-201301. Phone: 0120-2532246

REGISTRATION FORM FOR DOMESTIC PIPED NATURAL GAS CONNECTION

I/We wish to register for a Domestic Piped Natural gas connection. Our particulars are given hereunder:

1) Mr./Ms./Mrs.

2) Father's/Husband's Name:

3) Address: House/Flat No:

Society /Apartment

Street/Area Name:

City:

State: Pin:

4) Telephone Nos. : Landline (Office)

(Residence) Mobile No:

5) Email:

6) Type of Ownership (Please Tick): Owner Rented

If rented, please submit NOC to be issued by the lawful owner of the property as specified below
PAYMENT DETAILS:
Pay Order/DD/Cheque No….............Date…………Drawn On…………Bank Name….………Favoring
“GAIL Gas Limited” Payable at.......................... Amount…………..towards Refundable Security Deposit
as per the terms and conditions stated overleaf. (Payment in Cash is not accepted)
Declaration:
1. I/We have read and understood all the terms and conditions as stated. I/ We accept and agree to the said terms and
conditions, as may be amended from time to time.
2. I/We agree that GAIL Gas Limited reserves the right to accept or reject this application for registration without
assigning any reason whatsoever.
Date:…………………………….
Name:………..............………………………………....……………Signature:………..………………..…….

List of Documents To Be Submitted:

• Proof of Identity (Any one of the PAN Card/ Passport/Voter Id Card/ Driving License/Ration Card)
• Proof of ownership of the establishment (Copy of Sale Deed Agreement/Rent Agreement/Electricity bill/BSNL Telephone
bill/Society Certificate etc.)

NO OBJECTION CERTIFICATE (TO BE FILLED BY THE LAWFUL OWNER)

(Applicable only if the premise is rented)

This is to certify that I, Mr./Ms./Mrs._______________________________am the lawful owner of the above mentioned property.
I have no objection, if the tenant of the property as mentioned above, avails domestic PNG connection from Gail Gas Limited.
Name…………………………………………………………………………....................………………………………
Permanent Address of the Owner:…………………………………………………...........................……………………
Telephone Nos. : Landline (Office)…….........................………………… (Residence).…………………………………
Mobile Nos:…………………………………………Email:……………………………………………………………...
Proof of Ownership (as enclosed)…………………………………………………………………………………………

Date:......................................................... Signature:.......................................................................
TERMS AND CONDITIONS FOR SUPPLY OF PIPED NATURAL GAS TO DOMESTIC CUSTOMERS have access to rectify any problem and maintain the equipment. Any unauthorized
The terms and conditions between M/s GAIL Gas Limited, (hereinafter referred to as “Supplier”) concealing / tampering / relocation of PNG installation is not permitted and shall be solely
and the applicant (hereinafter referred to as “Customer”) for the supply of piped natural at the risk and cost of Customer. In such cases, the Supplier would forfeit the security
gas, are stated below: deposit of Rs. 5,000/-. The Supplier reserves the right to discontinue PNG supply in case
1 "Supplier" means GAIL Gas Limited. PNG equipments has been interfered with.
2 "Customer" means the applicant for a domestic Piped Natural Gas (PNG) connection. 10 The Customer shall ensure access to the meter reader, authorized by GAIL Gas Ltd., for
3 "PNGRB" means Petroleum and Natural Gas Regulatory Board. periodical meter readings and maintenance checks.
4 "Last Mile Connectivity (LMC)" means equipments and installations used for providing 11 The Customer shall ensure the proper & timely payment of gas consumption bills, which
PNG connection as defined in PNGRB Regulations 2008. shall also include the LMC charges, and/or Network Tariffs decided from time to time in
5 "SCM" (Standard Cubic Meter of GAS) means a quantity of GAS required to fill One (1) accordance with the PNGRB Regulations 2008. Customer shall make full payment, against
cubic meter of space when the GAS is at an absolute pressure of seven hundred and sixty the bill raised by the Supplier within 21 days from the date of billing. Any default in the
(760) millimeters of mercury and a temperature of fifteen (15) degrees Celsius. payment of bill will attract a penal interest of 2% per month. Non receipt of PNG
consumption bill shall not be sufficient ground for non-payment of bills. In case Customer
Supplier's Rights and Obligations has not received Quarterly bill he/she is under obligation to obtain a duplicate copy of
1 After receipt of the duly completed registration form together with the required interest free same from the Supplier.
refundable security deposit, the Supplier shall commence to take steps to provide the PNG 12 In case the Customer fails to pay two consecutive bills, gas supply will be discontinued
connection to the Customer. The Supplier shall make all efforts, as a prudent City Gas without any notice. The supply shall only be resumed by GAIL Gas Ltd. after clearance of
Distribution Company to install the connection within reasonable time from the date of all the outstanding bills with applicable interest. A minimum amount of Rs.1000/- shall be
registration, subject to the availability of access to the Customer's premises. charged as re-connection charges to cover the expenses involved in disconnecting &
In the event of any delay, due to non-availability of requisite permissions from land owning reconnecting the supply. In such cases, Supplier reserves the right to resume PNG supply
agencies of the area / society, the Customer may exercise the option to ask for the refund with Smart-Card enabled metering system.
of their security deposit. The Supplier shall refund the interest free security deposit in the 13 All the payments shall be made by as per the modes evolved by the supplier from time-to-
event of non-feasibility of providing the PNG connection to the Customer due to technical time. Following modes of payment shall be acceptable by the supplier:
reasons, which the Supplier may discover at the time of execution of the work availability a) Cheques
of installation of the connection. b) Demand Draft
2 The Supplier shall supply the gas at a pressure of 21 millibar to all the domestic customers c) Electronic Fund Transfer
and maintain the maximum flow-rate of 0.75 SCM per hour only for kitchen application d) RTGS, etc.
only. However the flow-rate may change for any additional application(s). 14 The customer in addition to the per unit cost of gas has to bear & pay, taxes levied as
3 The Supplier reserves the right to select safe and best possible pipeline route to provide applicable from time to time.
PNG connection to individual residential units having necessary safety and statutory 15 Supplier may install a Smart-Card enabled gas meter as part of PNG installation and the
clearances. same shall be acceptable the customer without any objections.
4 The Supplier shall convert the existing LPG burners to make it compatible for use on PNG 16 Customer can buy / recharge prepaid smart cards for supply of PNG from various
for the first stove / appliance. Any subsequent conversions would be carried out on authorized channels made available by the Supplier from time to time. For Customers
payment of applicable charges as prevailing at the time of receipt of the request. provided with smart card enabled gas metering system, Clause No.09 & 10 under
5 Meter reading shall be taken during the period commencing 10 days prior to the last date of Customers' rights & obligations shall not be applicable.
respective billing cycle. Quarterly bill shall be raised on the Customer on the basis of 17 In case the Customer desires to surrender the PNG connection, the Customer would be
actual meter reading converted into Standard Cubic Meter (SCM) by applying correction required to submit a written request along with the original receipts of payment made
factor. In case inspite of best efforts the meter reading is not recorded due to any reason at towards the payment of refundable security deposit. The security deposit would be
Customer's end, a provisional bill of Rs.250/- will be raised and the difference in the released after deducting the final bill amount and other dues, if any, after taking the meter
amount if any will be adjusted in the next bill on the basis of actual meter reading obtained. and other fittings in the safe custody of the Supplier.
In such case if the customer desires the bill based on actual meter reading, he/she may 18 Customer understands that rubber tube is a consumable component of PNG installation.
inform the current meter reading to the supplier within 5 days from the last date of Customer is under obligation to get it replaced annually with payment of applicable
respective billing cycle through email : [email protected] or through letter containing the charges. Customer shall also ensure that if at any time during the usage/non-usage of PNG
complete details including the Meter Number and Business Partner Number. connection, any damage is detected in the rubber tube, PNG supply should be stopped
6 Each Meter shall be treated as a separate PNG connection. Extension from one floor to immediately and a request for replacement of damaged rubber tube with applicable
another shall be treated as new connection. However, extension in the kitchen on the same charges should be placed with the Supplier. No request for compensation/adjustment in
floor can be provided with extra charges as per prevailing rates. the PNG consumption bill on account of leakage of gas caused due to damage of rubber
7 The modification of existing PNG installation may be carried out on request of the tube shall be entertained.
Customer along with the payment of applicable charges (Non-Refundable) as prevailing at General:
the time of receipt of such request. Acceptance of any such request for modification is 1 Supplier reserves the right to reject any application for registration by intimating the basis
subject to conformity to relevant technical and safety standards. for rejection of the application to the applicant.
8 If the banking instrument issued by the Customer gets dishonored for any reason, 2 Supplier reserves the right to provide an additional PNG connection for use in heating &
administrative charges of Rs. 100/- shall be levied and recovered from the Customer in cooling application (i.e. domestic Geyser & Air Conditioner) on request of the Customer
addition to interest, if any, without prejudice to the right of the Supplier to initiate along with the payment of applicable charges (Non-Refundable) as prevailing at the time of
appropriate legal proceedings and bankers charges against the Customer for the said receipt of such request & additional connection for Gas based gensets for domestic supply
dishonour. purposes.
9 The Supplier shall not use Customer information obtained for a purpose other than for 3 Prices of domestic PNG are subject to change and Supplier reserves the right to revise the
which it was obtained. The Supplier shall not disclose the Customer's information to any prices at any time.
person/entity other than the Petroleum and Natural Gas Regulatory Board (PNGRB), 4 The Supplier reserves the right to revise LMC charges and Network Tariff for the Last Mile
Central and State Governments and other statutory authorities without the consent of the Connectivity (LMC) at any time. Such charges and tariffs would be in accordance with the
Customer in writing except for the following purposes: PNGRB Regulations 2008.
a) Billing or Market Operation 5 After Sales Service (list placed below) shall be provided by the supplier on payment of
b) Law enforcement applicable charges (Non-Refundable) as prevailing at the time of receipt of such request.
c) When past due accounts of the customer have been transferred to a debt collection
agency.
10 Supplier shall take all reasonable steps to ensure a regular and consistent supply of PNG After Sales Services
to the Customer. However, in the event of any interruption due to force majeure like natural
S.No Particulars
calamities, war and other unforeseen events etc. beyond the control of Supplier, the
1 Bathroom Point
Customer shall have no claim whatsoever, for the interruption of the supply. However, the
2 Kitchen or Bathroom Pipeline Modification
supplier, as a prudent City Gas Distribution Company shall make all efforts to restore the
3 Removing & Refitting inside house GI/Cu Pipeline
PNG supply at the earliest
4 PE Route modification inside Customer premises
11 The Supplier shall inform the PNG Customers through RWA / Managing committee of the
5 Removal, Reffitment, Modification with PE & GI/Cu Re-Routing
affected society/area/colony of any planned shut down for undertaking maintenance
6 Full Connection Removal & Refitting
activity in their respective areas.
7 Additional Pipeline laying/Pipefitting
Customers' Rights and Obligations:
8 PE pipeline laying through Boring
1. Customer shall submit a Cheque/Demand Draft/Pay order of Rs 300 as application fee
9 GI Riser Shifting
along with the application form for PNG Domestic Connection.
10 SR Shifting
2 An interest free refundable security deposit of Rs. 5000/- per domestic connection shall be
11 RCC Guard Replacement
deposited through cheque/DD/PO payable at par in………………(name of the city) in favour
12 Wire braded flexible hose replacement
of "GAIL Gas Limited" towards the security of the equipments and facilities as defined in
13 Additional burner conversion in case of already converted stove has been replaced by
the PNGRB Regulations 2008. The payment shall be collected in following phases:
customer-charges for 2 Burner stove
I. Registration Chares @ Rs. 500/- at the time of Registration for a domestic PNG
14 Conversion of Additional Burner (per burner charges)
connection and non-refundable application charges @ 300/-
15 Gas Tap Replacement
II. Installation Charges @ Rs. 4500/- before regulator & meter installation work.
16 Isolation Valve Replacement
3 The customer is required to deposit Rs. 500/- towards bill payment security deposit
17 Riser Isolation Valve
(refundable) towards bill for gas consumption, at the time of starting the gas supply.
18 Disconnection
4 The domestic PNG Customer shall bear the cost of material and labour charges for GI pipe
19 Reconnection
in excess of 10 meters before metering unit & tube/pipe in excess of 5 meters after
20 Name Transfer Charges (Except Death)
metering unit excluding rubber tube, as per rates applicable at the time of execution and as
declared by the supplier.
5 It shall be the responsibility of the customer to provide access to the route as decided by
the Supplier for laying of pipeline inside the boundary wall of the premises of his/her
residence. However, in case of flats located in multi storey housing societies, the
6 Supplier reserves the right to amend/modify any or all of the terms and conditions with
Customer shall arrange NOC, if required for laying of pipelines, through the common
intimation to the Customer.
portions/areas/walls inside of such housing complex, from the person/society concerned.
7 The Supplier reserves the right to supply PNG to other Customers through the same
In the event of non-receipt of such clearance in a reasonable time frame Supplier shall
pipeline at any point therein up-to the meter outlet/isolation valve without affecting the
cancel the registration and refund the security deposit.
customer's PNG supply.
6 The Customer undertakes to provide the Supplier with the proof of requisite safety and
8 Any dispute arising out of/in relation to this agreement shall be decided by the arbitrator
statutory clearances from the competent authority at the time of registration. The Customer
who shall be CEO of GAIL Gas Ltd. or his/her nominee. Arbitration & Conciliation Act 1996
is under obligation to provide the proof of ownership/tenancy of the premises to the
and any other modifications thereof shall be applicable to the proceedings. Venue of
satisfaction of the Supplier at the time of submission of the registration form.
arbitration shall be Delhi/Noida only.
7 The Customer shall make use of the PNG supply for domestic purpose only and that too in
9 Not withstanding any other court(s) having jurisdiction to try these suits arising out of this
the registered premises only and shall not re-supply to any other person or property under
agreement, only court of Delhi/Noida shall have exclusive jurisdiction to try such suits to
any circumstances.
the exclusion of all other courts in the Country.
8 All fittings & equipments as provided by the Supplier for the purpose of supply of PNG
shall remain the property of the Supplier. The Customer shall remain the custodian of such
properties and shall ensure the safety of these equipments.
9 The Customer will not permit interference with PNG equipment and supply line by any
person not authorized by GAIL Gas Ltd. Only the Supplier's authorized representative will
ACKNOWLEDGEMENT FOR DOMESTIC PIPED NATURAL GAS CONNECTION
Form No …………………………
Date of Receipt of Registration: ..........

Received from ..............:………………………………………………………… Address:…………………………………………………………

..............................................................................................................................On:….........…………………………………..completed Registration Form and payment of
Rs:……………………………………....... By P.O./DD/Cheque No:..................... Dated…………………………..... Drawn on……………………………………

Date:................................................ (Authorised Signatory).............................................................