APPLICATION FOR OFFER OF OPEN PLOTS TO SET UP A CNG STATION BY WAY OF LONG -TERM LEASE

(Landowners shall be awarded Dealership of the CNG Sta on based on their suitability)

Applica on No. (for office use):

Loca on:
For
Dra No. Dated Individuals/Partners

Adver sed on in by MNGL (Please affix a recent

passport size
Applied for Loca on Photograph)

(Please go through the Informa on Brochure available on our website

carefully before filling in this applica on form)

1. Individual:
(Individuals to enclose Affidavit as per Appendix – A. The candidates called for interview will also have to
submit a fresh Affidavit, signed and notarised not earlier than 3 working days prior to the date of interview,
failing which the candidate will be considered as ineligible for Dealership)

a) Name (In Blocks):…………………………………………………………...…………………………………………………………..…………

b) Father’s Name/ Husband’s Name:…………………………………………………………………………………………………………

c) Date of Birth (A ach proof of date of birth):……………………………………………………………….…………………………

d) Qualifica on (A ach proof of qualifica on):…….……………………………………………………………………………………

e) Address of Communica on (A ach address proof):….………………………………..…………………………………………

………………………………………………………………………………………………………………………………………………………………….

………………………………………………………………….………………………………………………………………………………………………

Tel.Nos:………………………………………………………………………………………………………………………………………………………….....

E-mail ID:…………..……………………………………………………………………………………………………………………….................

f) Na onality:….….……………………………………………………………………………………………………………………………………..

g) Gender:………………………………………………………….. h) Marital Status:…………………………………………………….

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i) What is your present occupa on? …………………………………………………………………………………………………………

j) If you are an Income Tax Assessed, please furnish your PAN:…………………………………………………………………

k) Do you have Business/Selling experience? (If Yes, give details).................................................................

………………………………………………………………………………………………………………………………………………………………....

l) Do you have experience of supervision of personnel? (If yes, give details)……………………………………………..

………………………………………………………………………………………………………………………………………………………………….

m) On a separate sheet, please give your detailed business plan/project report to run a CNG Sta on

2. Firm:
(Registered Co-Opera ve Socie es, Organised Bodies, Fleet Operators, Charitable Trusts, Partnerships and
Corporate Houses to enclose Affidavit as per Appendix – B. Those called for interview will also have to
submit a fresh Affidavit, signed and notarised not earlier than 3 working days prior to the date of interview,
failing which the candidate will be considered as ineligible for Dealership)

a) Name of the firm:………………………………………………………………………………………………………………………………….

Type of firm: Partnership/Private/Public Limited/Others…………………………………………………………………………..

(A ach copy of incorpora on/registra on/proposed partnership deed)
(In case of partnership, each partner has to make separate applica on. Also, each partner has to
individually submit affidavit as per Appendix - A)

b) Address of the firm: ………………………………………………………………………………………………………………………………

………………………………………………………………….………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………….

(c) Contact no. (Off) 1. ………………………………………………… 2.……………………………………………………………………….

(Fax): …………………………....…………………………………… (Mobile): .………………………………………………………………..

Email Id: …………………………....…………………………………………….……………………………………………………………………….

d) Please enclose copies of audited Profit & Loss Account Statement for previous 3 years

3. Site details:
(In case of site having more than one owner, and if more than one owner wishes to apply, then separate
applica on to be filled up individually by each owner of offered site)

a) Name of the owner(s) of the site: …………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………….

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b) Rela onship of land owner with the applicant:……………………………………………………………………………………..

c) Loca on of the plot:..…………………………………………………………………………………………………………………………….

d) Schedule or Descrip on of the plot as per

e) Title/Ownership Document:……..………..……

…………………………………………………………………………………………....……………………………………………………………………

f) Name of the road: …………………………………………………………………………………………………………………………………

g)City survey no. of plot & Village:………………………….…..…………………………………………………………………………….

g) Are you willing to transfer the land to MNGL on long lease? YES / NO
(Preference will be given for longer lease period offered by the applicant/s)

If Yes, at what rate (in figures & words)?.............................................................................. (Rs/ Sq. Mtr.)

For how many years (in figures & words)?...............................................................................................

Other terms?....................................................................................................................................................

h) Area of the plot (In Sq mtrs):...………………………………………………………………………………………………………………

i) Frontage available (In mtrs):….…………...……………………………………………………………………..………………………….

j) Depth of the plot (In mtrs):……………….……………………………………………………………………………………………………

k) Zone:………………………………………………………………………………………………………………………………………………………………

l) Details of the surroundings: (Indicate approximate distance between the surroundings and plot
boundary. E.g. East: School/150 meters)

East: ………………………………………………………………………………………………………………………………………………………….

West: ………………………………………………………………………………………………………………………………………………………..

South: …………………………………………………………………………………………………………………………………………………….…

North: ……………………………………………………………………………………………………………………………………………………….

Distance from nearest road junc on: ……………………………………………………………………………………………………....

Distance from gate of nearest school/hospital/theatre/place of assembly or stadium: ...............................

m) Availability of power connec on: …………………………………………………………………………………………………..……

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n) Availability of water connec on:..…………………………………………………………………………………………………………

o) Encroachments, if any:..………………………………………………………………………………………………………………………..

p) Details of any adjoining roads (main road, service road etc., indicate width of road):…………………………….
………………………………………………………………………….………………………………………………………………………………………

q) FSI available: ...………………………………...…………………………………………………………………………………………………..

r) Is any path way crossing the land? YES/NO (If Yes, width of pathway)….……………………………………………

s) Any high voltage transmission lines nearby? YES / NO

If yes distance from the plot/which direc on: …………………………………………………………………………….. in mtrs.

t) Local Municipality/Ward:...………………………..………………………………………………………………………………………….

u) Nearest police sta on:………………………..…………………………………………………………………………………………………

v) Nearest fire sta on:.………………………...………………………………………………………………………………………..…………

w) Whether tle of plot is clear, marketable and undisputed? YES / NO

(If YES please furnish copy of latest Search & Title Report by a Senior Advocate (A ached Report must be
within 3 months from the date of Applica on)

x) Whether land is, at any me, covered in Govt. Acquisi on plan? YES / NO

y) Whether the owner has received any no ce of any type from any statutory body/agency (including
any Oil Marke ng Company) for the referred plot? If yes, details there of:
….…………………………………………………………………………………………………………………………..………………………………….

Google Coordinate of the offered land …………………………………………………………………………………………………….

z) Whether any civil/criminal suit or an appeal or miscellaneous applica on is filed/pending in any court
of law/tribunal/competent authority in respect of the said land? If yes, details thereof:

………………………………………………………………………………………………………………………………………………………………….

4. Sources of Funds:

(To be provided by all applicants, and supported by Bank Cer ficate as per Appendix C)

The details to cover free & unencumbered Bank accounts/Govt. Securi es/ fixed deposits, bankers/financial
ins tu on cer ficate for credit worthiness (in the enclosed Appendix - C), loans, UTI, NSC, Bonds, Shares of
Public Limited Companies etc., details of other assets like immovable property (land, building etc.). Movable
proper es like vehicle etc., any other sources of income like from interest, rent, business etc. (please a ach
proof in all cases). The details under “Finance” may be provided in the following format: (A ach Separate
sheet as required)

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 Type Details of A/c #, etc. Name of the Holder Rela onship Amount

5. Any Other Details:

……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………
Affidavits are to be enclosed in original duly Notarized with Registered Serial No. In respect of all the
documents listed below, duly a ested Photo copy / True copy / Original / Cer fied (as men oned) need
be a ached along with the applica on. However, originals of all these will have to be brought at the me
of interview, if called for.

1. Cer fied Copy of Ownership / Title Document

2. Search & Title Report by Advocate of the Applicant
3. Notarized Affidavit of Title of Ownership (Appendix D) on Rs. 100 stamp paper
4. Property card or 7/12 extract of a recent date (original) i.e., (A ached Property Card or 7/12 extract
must be within one month from date of applica on)
5. Ferfar/Muta on Record/Entry (original)
6. Latest Demarca on Plan (Original); a ached plan must be within 3 years from date of applica on
submission
7. Details of Offered plot in the total plot on Cer fied copy of Demarca on Plan issued within 3 years from
the date of applica on submission date (copy)
8. Cer fied copy of latest Sanc oned road DP plan from local Authority
9. Latest DP opinion of the total plot from Local Municipal Corpora on or any other Equivalent Authority
(Cer fied Copy)
10. Zone Cer ficate (copy)
11. Previous 5 years property tax/dues payment receipts along with latest tax NOC (Original)
12. Partnership Firm :
a) Registered Partnership Deed along with cer ficate of registra on (Cer fied Copy)
b) Proposed Partnership Deed duly notarized
13. Cer ficate of Registra on for Co-opera ves/Corporate Bodies
14. Document clearly indica ng Commercial Status of the offered site
15. FALNI Map/Subdivision Map (if applicable)
16. Land Lease agreement between MIDC & applicant (as applicable, Cer fied Copy)
17. Survey Plan issued by MIDC and Plot Handover le er with one cer fied copy(applicable for sites in
MIDC area)
18. NOC from Landlord in case of lease hold land(Copy)
19. NOC from MHADA, MIDC, Municipal Corpora on or applicable local authority (Copy)
20. Advocate Opinion
21. Consent le ers from concerned in line with format{as applicable} on Rs. 100 stamp paper duly
notarized

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22. NA order as applicable (Copy)
23. Par on/Distribu on Deed(In case of Family Par on / Distribu on, Cer fied Copy)
24. Firm “allotment le er “ issued by Govt/Semi-Govt bodies (if applicable, Cer fied Copy)
25. In case Applicant is registered power of A orney Holder then Notarized Affidavit from all owners
sta ng that PoA is not revoked / cancelled / terminated and is s ll in existence - (Appendix E) on Rs. 100
stamp paper (Cer fied Copy of Registered PoA)
26. Proof of Date of Birth (Copy)
27. Proof of Residence (Copy)
28. Proof of Educa onal Qualifica on (Copy)
29. Proof of Photo Id & address (copy-Aadhar card)
*Above documents shall be submi ed along with the applica on form (including relevant Appendices).
Cer fied copy means Cer fied from the concerned Authority i.e., Sub-registrar office, Revenue office,
Registrar of Partnership Firm, Registrar of Co-opera ve Soc., etc.
THIS IS NOT THE EXHAUSTIVE LIST. THE APPLICANT(S) SHOULD CAREFULLY GO THROUGH THE
"BROUCHURE" BEFORE SUBMITTING THEIR APPLICATION(S).

Please Note:
1. The Applica on Form is to be submi ed along a with non-refundable processing fee of Rs. 5000.00 by
way of Demand Dra /Cheque (in favour of 'Maharashtra Natural Gas Limited' payable at Pune)
2. Preference will be given to land situated on/nearby MNGL exis ng and proposed pipeline
3. Property tax and other statutory charges on the property and on lease rental will be borne by the
applicant/landowner
4. No addi on/dele on/altera on will be permi ed in the applica on once it is submi ed. Also, no
strike-outs, cancella ons, over-wri ngs are permi ed in the applica on form

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 UNDERTAKING

I undertake to produce Originals of all the a achments enclosed with this applica on at the me of
interview, if called and is aware that in the event! fail to produce the originals, my offer of land for long term
lease and my applica on for Dealership will be disqualified. I am fully aware that Maharashtra Natural Gas
Limited, under its policy will not append me as their Dealer if I am employed. I shall hate to resign from the
service and produce proof of acceptance of my resigna on by my employer to MNGL before issuance of
Le er of award by MNGL.

That, if selected, I undertake that I will be required to deposit an interest free Security Deposit & variable
security deposit as per the details in the Adver sement against which this applica on is being made.

I, hereby cer fy that the informa on given above

is true to the best of my knowledge and belief. Any wrong informa on / suppression of facts will disqualify
me from being considered for the Dealership.

Place:

Date: Signature

Applica on with all the informa on and documents a ached should be submi ed in person or by hand at
the following address. For further details please visit www.mngl.in

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 APPENDIX ‐ A

(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

AFFIDAVIT FOR INDIVIDUALS & PARTNERS

I, son/daughter/wife of
Age years residing at

do hereby solemnly affirm and say as under:

1. That I am an Indian Na onal.
2. That I am married/unmarried.
3. I have never been convicted and/or no process has been issued and/or no charges have been framed by
a Court of law against me for any criminal offence involving moral turpitude/ economic offences (other
than freedom struggle).
4. I hereby confirm that I was never a signatory to a dealership/distributorship agreement of any oil
company, which was terminated for proven adultera on/malprac ces.
5. That details of various sources of funds required for se ng up and opera on of the Dealership have
been furnished. I undertake that these funds will be made available for the purpose stated above. In
case it is found that the same is not made available as and when required, the offer of Dealership, at any
stage, can be withdrawn and that I will have no claim/damages whatsoever against Maharashtra
Natural Gas Limited.
6. I hereby verify that what has been stated above is true to the best of my knowledge and belief and
nothing material has been concealed thereof. If any informa on/declara on given by me in my /our
applica on or in any document submi ed by me/us in support of applica on for the selec on of land
for CNG sta on and/or award of Dealership or in this affidavit shall be found to be untrue or incorrect or
false, Maharashtra Natural Gas Limited would be within its rights to withdraw the le er of intent /
terminate the lease of land/Dealership (if already appointed) and that we would have no claim,
whatsoever, against Maharashtra Natural Gas Limited or its employees for such
withdrawal/termina on.

Solemnly affirmed and declared before me

This day of

Signature and Seal of Signature of person making Affidavit

Magistrate/Judge/Notary public (Name in block le ers):

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 APPENDIX - B

(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

AFFIDAVIT TO BE SUBMITTED BY REGISTERED CO-OPERATIVE SOCIETIES, ORGANISED BODIES,

CHARITABLE TRUSTS AND CORPORATE HOUSES

In the ma er of offer of land for CNG Sta on on long term lease basis and Dealership of such CNG sta on of
Maharashtra Natural Gas Limited at (Loca on)
Whereas (Name of the Co-opera ve Society*/organised body*)
(Address)
has offered land and applied for Dealership of such CNG sta on of Maharashtra Natural Gas Limited, at our
offered land at (Loca on)

I, son/daughter/wife of Age years

resident of in the capacity of do hereby solemnly declare:

1. That through a resolu on passed by the Co-opera ve society*/organized body* I have been
authorised to offer the said land to MNGL on long term lease basis and apply for the said Dealership of
the CNG sta on on such land. A copy of the resolu on / authorisa on is enclosed herewith forming
part and parcel of this affidavit.
2. That the said Co-opera ve Society*/organised body* is duly registered and a duly a ested photocopy
of the registra on cer ficate is enclosed herewith forming part and parcel of this affidavit.
3. That on behalf of the Co-opera ve Society*/organised body*, I undertake that I will observe all the
relevant guidelines with regard to award/opera on of the said lease and Dealership issued by
Maharashtra Natural Gas Ltd from me to me.
4. That none of the members of the Co-opera ve Society have been convicted and/or no process has
been issued and/or no charges have been framed by a Court of law against them for criminal offences
involving moral turpitude and / or economic offences (other than freedom struggle). A copy of the
cer ficate to this effect from the Registrar of Coopera ve Socie es is enclosed herewith forming part
and parcel of this affidavit. (Applicable for coopera ve socie es/consumer socie es only).
5. That the Co-opera ve Society*/organised body* does not have any criminal records nor does it have
any criminal charges framed against it by court of law involving moral turpitude and/or economic
offences.
6. That there is no dispute pending u/s of the State Co-opera ve Society Act, by or against the society or
any of its member.
7. That no administrator has been appointed by an order of any Co-opera ve Court/Tribunal /Registrar of
Co-opera ve Socie es to look into the affairs and day to day func oning of the society.
8. That the Co-opera ve Society*/organised body* was never a signatory to a dealership/ distributorship
agreement of any oil company, which was terminated for proven adultera on / malprac ces.
9. That the details of various sources of funds required for se ng up and opera on of the Dealership has
been furnished. I undertake that these funds will be made available for the purpose stated above. In
case it is found that the same is not made available as and when required, the lease agreement and
offer of Dealership, at any stage, can be withdrawn and that will have no claim/damages whatsoever
against Maharashtra Natural Gas Limited or any of its employees.

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10. I hereby verify that what has been stated above is true to the best of my knowledge and belief and
nothing material has been concealed there from. If any informa on/declara on given by me in my
applica on or in any document submi ed by me in support of my applica on for the offer of land on
long term lease or award of the Dealership or in this affidavit shall be found to be untrue or incorrect or
false, Maharashtra Natural Gas Limited would be within its rights to withdraw the le er of intent /
terminate the lease agreement and / or Dealership (if already appointed) and that I would have no
claim, whatsoever, against Maharashtra Natural Gas Limited or any of its employees for such
withdrawal/termina on.

*strike out whatever is not applicable. Solemnly affirmed and declared before me
This day of

Signature and Seal of Signature of person making Affidavit

Magistrate/Judge/Notary public (Name in block le ers):

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 APPENDIX - C

(CREDIT WORTHINESS CERTIFICATE FROM THE BANKERS, FROM SCHEDULED BANK/FINANCIAL

INSTITUTIONS TO BE OBTAINED ON THEIR LETTER HEAD IN THE FOLLOWING FORMAT AND
ENCLOSED WITH THE APPLICATION)

To whomsoever it may concern

Shri /Ms /M/s. is a customer of this bank / ins tu on for last years
and he / she / they, is/are enjoying the following facili es of our bank /ins tu on:

a.
b.
c.

During the above period, the dealing of Shri /Ms / M/s with
the bank and he /her / their conduct has been sa sfactory. In case, Dealership of CNG Sta on is allo ed
to him / her / them, we will be willing to extend a loan of (Rupees )(in words).

Signature
Name and Designa on:
Office Seal:
Date:

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 APPENDIX – D

(AFFIDAVIT OF OWNERSHIP OF PROPERTY/OFFERED LAND TO BE SUBMITTED BY THE ORIGINAL

OWNERS ON RS. 100 STAMP PAPER AND DULY NOTARIZED WITH SERIAL NUMBER)

AFFIDAVIT / UNDERTAKING

I, Mr./Mrs.

Age:- Occ:- Residing at:-

do hereby state and

declare on solemn affirma on as under :-

Descrip on of property :-

That I / We hereby Declare, Represent and Assure to whomsoever it may concern :-

a) That I/We is/are Sole/Joint and absolute Owner/s OR Holder/s OR Occupier/s OR Lessee of the
property / ancestral property as men oned above and the same is standing in my/our name/s in the
books and all other Revenue records maintained by the Government and I/We is/are absolutely
en tled to the same and to all incidental rights thereto and to the exclusive/joint right/s to the use,
enjoyment and occupa on of the property and except Me/Us, no other person or persons have any
right, tle, interest, claim or demand of any nature whatsoever upon the property;
b) That notwithstanding any act, deed, ma er or thing whatsoever done, omi ed by me/us or any person
or persons lawfully or equitably claiming by, from, through, or in trust, I/We have full power and
absolute authority in my/our own rights to Transfer/Lease the said property in favour of any third
person;
c) That neither me/us nor any one on my/our behalf have commi ed or omi ed any act, deed, ma er or
thing and incidental rights thereto including the right to peaceful use, occupa on, ownership and
enjoyment of the said property and other rights and benefits in respect thereof may become or may be
prejudicially affected or encumbered in any manner and their other right, tle and interest therein may
become liable to a achment and/or sale whether by a decree or order of the Competent Court or
otherwise;
d) That I/We have not created or purported to create any tenancy, license, charge, lease, mortgage, lien or
any kind of third party rights over the said property and no other person or party have any right, tle or

12
 interest, claim or demand in to or upon the same either by way of mortgage, gi , trust, inheritance,
lease, acquisi on, requisi on or otherwise and that the same are free from all encumbrances and
there is no pending li ga on of any kind whatsoever;
e) That the prospec ve Lessee shall on execu on of the Lease Deed peaceably and quietly be en tled to
hold and own the said property and all incidental thereto including the right to enter upon and remain
in sole occupa on and enjoyment of the said property and/or any part thereof without any
interference disturbance, interrup on, claim or demand whatsoever and/or any person or persons
lawfully and equitably claiming by from, through, under or in trust for me/us;
f) That I/We have not received any no ce for acquisi on or requisi on in respect of the said property;
g) That I/We have duly paid and discharged in full all the dues and liabili es in respect of the said property
including the Pune Municipal Corpora on /Pimpri Chinchwad Municipal Corpora on/Gram Panchayat
outgoings taxes, rates, charges etc. payable to the said concerned authori es unto the date hereof;

h) That I/We shall keep the prospec ve Lessee safe and indemnified against all claims, demands, suits,
ac ons, proceedings, loss, damages, costs, charges, expenses of whatsoever nature which may be
made or brought or commenced against the prospec ve Lessee, or be paid, sustained, suffered or
incurred by the prospec ve Lessee as consequent direct or indirect by reason of tle of ownership to
the said property and which may prejudice the prospec ve Lessee's interest.

That whatever is stated hereinabove is true and correct to the best of my / our knowledge and belief and
I/We have signed on this day of -20 .

Place:
Dated:
AFFIANT

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 APPENDIX – E
(ONLY FOR REGISTERED POWER OF ATTORNY HOLDERS)

(AFFIDAVIT TO BE SUBMITTED BY THE ORIGINAL OWNERS ON RS. 100 STAMP PAPER AND DULY
NOTARIZED WITH SERIAL NUMBER)

AFFIDAVIT / UNDERTAKING

I, Mr./Mrs.

Age:- Occ:- Residing at:-

do hereby state and

declare on solemn affirma on as under:-

Descrip on of property :-

That I / We hereby Declare, Represent and Assure to whomsoever it may concern:-

a) That I/We is/are Sole/Joint and absolute Owner/s OR Holder/s OR Occupier/s OR Lessee of the
property / ancestral property as men oned above and the same is standing in my/our name/s in the
books and all other Revenue records maintained by the Government and I/We is/are absolutely
en tled to the same and to all incidental rights thereto and to the exclusive/joint right/s to the use,
enjoyment and occupa on of the property and except Me/Us, no other person or persons have any
right, tle, interest, claim or demand of any nature whatsoever upon the property;
b) That notwithstanding any act, deed, ma er or thing whatsoever done, omi ed by me/usor any person
or persons lawfully or equitably claiming by, from, through, or in trust, I/We have full power and
absolute authority in my/our own rights to Transfer/Lease the said property in favour of any third
person;
c) I state that I have executed a Power of A orney dated --- registered in the office of Sub- Registrar ------,
Serial No. ------ executed by me in favour of Mr/Mrs.---- in respect of the said property.
d) I hereby confirm state and declare that the said Power of A orney dated -------- registered in the office
of Sub-Registrar --------, Serial No. --------- is s ll in existence in favour of Mr/Mrs.------------- ll today,
and I have not Cancelled, Revoked or Terminated the said Power of A orney.

That whatever is stated hereinabove is true and correct to the best of my / our knowledge and belief and
I/We have signed on this day of -20 .

Place:
Dated:
AFFIANT

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