Doc No : COM-F-70 B
Name Change Form (Domestic) Rev No : 0
Eff. Date: 01/02/2020
Application for Name Change (Domestic)
Customer ID:
Old Customer’s Name:................................................................................................................ Date::...............................................................................
Gas Connection’s Address:......................................................................................................... Request No. .....................................................................
......................................................................................................... Old Customer’s Phone No. .........................................
Respected Sir/Madam,
You are herewith informed with regards that I am submitting application with necessary documents for change in name for the above
mentioned Gas Connection for below mentioned reason. Hereby, I give assurance that all terms and conditions of the agreement applied to
old Customer shall be applied and binding to me.
Reason for Name Change:
(1) Sell of Property (2) Demise of Customer (3) Change in Surname (4)Other reasons: ...................
×.....................................................................
Name of Transferee (Name of New Customer) Old Customer’s Signature (Builder’s Signature/Stamp)
Name (First Name) Name of Father/Husband (Medium Name) Surname
Note: The utilization of gas bill shall be limited to gas connection only. In case, if it is used for evidence of ownership of property then Gujarat Gas Limited shall
not be responsible for its verification.
New Customer’s Phone No. .................................
×..........................................................
Documentary Proof of Submission: New Customer’s Signature
Sell of Property Demise of Customer Surname – Name Change Other
→Householder’s proof (any one copy) Copy of Death Registry Copy of Government Gazette /
(Old and New both as applicable)
Tax bill of current year Succession certificate-Heirs consent sheet Affidavit of Surname
Registered Sale Deed (new and old) On Rs. 100/- Stamp Paper Notarized (with ID →New Customer’s ID
proof)
Possession receipt →House Ownership proof (any one) (Any one copy)
(Old and New both as applicable)
Property Index (new and old) Prevailing year’s Tax bill) Driving License
Current 7-12 Form Registered Sale Deed Pan Card
→New & Old Customer’s ID Card Possession Receipt Passport
(any one copy) Property Index Voter’s ID
Driving License Prevailing 7-12 Form Adhar Card
Pan card Passport →Prevailing Year’s Tax Bill
Voter’s ID Adhar Card →Customer’s ID (any one copy)
→Old Customer’s Consent Sheet Driving License
Back leaf of the Form Pan card Passport
Voter’s ID Adhar Card
Deed, Property Index and Index copy should be registered and notary is required.
If copy of document, possession receipt and property index is more than 4 years old then copy of tax bill (current year) shall be necessary.
In the proof of ownership and identity; name and surname shall be necessary.
In case more than one owner; NOC from other owners shall be submitted mandatorily (Back leaf of the Form).
Self-attested copy of above mentioned all proofs shall be submitted.
Application of name transfer shall be subject to documents verification.
The process fee of name transfer shall be paid.
Customer shall have to pay outstanding installments and other payable amount.
(Customer’s copy) Application for Name Change
Customer ID :
Old Customer’s Name: ........... ........... ...... ...... .....
Address of Gas Connection:............................................................................................................................................................................................................
Date: ............................................. Request Number: ................................
Process fee of name transfer shall be paid.
The customer will have to pay the balance due in full. .
Application of name transfer shall be subject to documents verification.
Note: The utilization of gas bill shall be limited to gas connection only. In case, if it is used for evidence of ownership then Gujarat Gas Limited shall not be
responsible for its verification.
Old Customer’s Consent Form
I (Old Customer’s Name): …………………………………………………………………………………………………………….…… hereby state and
declare that I had obtained M/s. Gujarat Gas Limited’s Pipeline Gas Connection, Customer Number: ………………………… at
address of my current gas connection site ………………………………………………………………………………………………………… …… …… ……
….……………………………………………………………………………………………………….., but now I have sold the above property along with
Pipeline Gas Connection; hence, I shall have no objection for transferring the said pipeline connection to ……… ……… ………
……… ……………………………………………………………. (new customer’s name) and moreover, I give assurance that in case of any
dispute / objection occur in future and in this regard whatever decision would be taken by Gujarat Gas Limited shall be
binding to me.
Date:
Place ……………….……………….……………….
Old Customer’s Signature (Builder’s Sign/Stamp)
Letter of Consent
(In case of joint ownership of property - NOC along with ID Proof should be submitted)
To,
Gujarat Gas Limited
Address of Gas Connection
.....................................................................................
................................................................................................................................................................................. ...................................
....................................................................... ...... ..... I / we, hereby give information to Gujarat Gas Limited and / or its auxiliaries
regarding self-ownership / joint ownership of above mentioned property that connection of Gujarat Gas shall be kept on
name of Mr./ Mrs.. …………………………………………………………………; he / she is my …………………………… (Relationship) and for the
same I/we shall not have any objection. Hereby I/we give assurance along with our consent that I/we shall not hold Gujarat
Gas Ltd. and/or its auxiliaries responsible and shall not make any claims now and in future in context to any loss / expenses
/ repairing of above property which may take place due to this gas connection.
Date:………………….
Place:………………….
×........................................ ×........................................
Sign of House Owner Name of House Owner
×........................................ ×........................................
Sign of House Owner Name of House Owner
×........................................ ×........................................
Sign of House Owner Name of House Owner
