—ȡš”ȯĚȪͧ›™˜€Ȩ”Ⱦšȯž“ͧ›ͧ˜ŠȯŒ f ȢŠȣȢŠȣfĤ”ğ

—ȡš š€ȡš`”Đ˜ SV/TV/TA- FORM

”Ȳ‡Ȣ€Ǚhͩ• kš€šȣ˜—Ȩ™šȪŒ”Ȫ–ȨÈ “ȯ›ȡŒ[^èŠȯŠ˜ǕȲ–_
BHARAT PETROLEUM CORPORATION LIMITED
(A GOVERNMENT OF INDIA ENTERPRISE)
REGISTERED OFFICE: BHARAT PETROLEUM CORPORATION LIMITED, BHARAT BHAVAN, 4& 6, CURRIMBHOY ROAD,
BALLARD ESTATE, P.B.NO. 688, MUMBAI - 400 001, CIN : L23220MH1952GOI008931 PHONE : 2271 3000 / 4000 FAX : 2271 3874
EMAIL : info@bharatpetroleum.in WEB: www.bharatpetroleum.in

S. NO. DOCUMENT TYPE SUBSCRIPTION VOUCHER

‘èȡȯ«ИȡȲ€ Ǒ‘“ȡȲ€
Ǔͬ˜ȡ¡Ÿ[ `”—ȪƠȡИȡȲ€
DOCUMENT NO. DATE (DD/MM/YYYY) CONSUMER NO.
4095795086 24/05/2018 92469114

ͫŒǔèĚޙǕŠš€ȡ€ȪŒ“ȡ˜kš”ȡDISTRIBUTOR CODE, NAME AND ADDRESS

123854, SUVIDHA GAS AGENCY, SHOP NO. 3,4, AMRIT SHREE MARKET BABATAL, SIHORA DIST - JABALPUR 483225

€“ȯȞ“ ”Ȳ‡Ȣ€šŽ `”€šŽ €ȪŒ “‚ šȡͧž

CONNECTION REGISTRATION EQUIPMENT CODE NOS. AMOUNT
Ĥ€ȡš ĮȯŽȢ ИȡȲ€ 52263294 ͧ ͧ›ȲŒš 14.2 SDOM 1 1450
TYPE CATEGORY NO. CYLINDER
DOM OTHERS Ǒ‘“ȡȲ€ 24/05/2018 šȯʙǕ›ȯŠš BPCDPR 1 150
DATE REGULATOR
€Ǖ›šȡͧžžÞ‘Ȫ˜Ʌ Rs. ONE THOUSAND SIX HUNDRED ONLY €Ǖ›šȡͧž 1600
AMOUNT IN WORDS TOTAL
`”—ȪƠȡ€ȡ“ȡ˜kš”ȡCONSUMER NAME AND ADDRESS
Mr. NITIN GUPTA , CHITRANCE BHAWAN WARD NO 13 JAY BHAWANI COLONI TESHIL JUNNARDEO 483225

”Ǖšȡ“ȡޙȪšȡOLD PARTICULARS ‘èȡȯ«DOCUMENT ИȡȲ€NO. Ǒ‘“ȡȲ€DATE

ͫŒǔèĚޙǕŠš€ȪŒ˜Ǘ› f –ȢŠȣȢŠȣf
DISTRIBUTOR CODE SV/ TV/ TA
ŠȯǐšŠšȣ€ȪŒ \Ǔǐš€ͧ ͧ›ȲŒšf –Ȣ
TERRITORY CODE ADDITIONAL CYLINDER S.V.
`”—ȪƠȡИȡȲ€ f –ȢŠȣȢŠȣf
CONSUMER NO. SV/ TV/ TA
ȯ›€Ȳ”“Ȣ
OIL COMPANY
ǐš€šȣh“\€ȡ`ȲŠh• ›ȨèŠ ͫŒ•ȯȊȣ
RECOVERY ON A/C OF LOST DEFECTIVE
ͧ ͧ›ȲŒš
CYLINDER
šȯʙǕ›ȯŠš
REGULATOR
ŒȢ–ȢŠȣf›\ȯŒȡȲ 
DBTL ADVANCE
€Ǖ›šȡͧž
TOTAL AMOUNT
ĚȡȲ •šŠǕͫŒǔèĚޙǕŠš€ȡ€ȪŒ“ȡ˜kš”ȡTRANSFER TO DISTRIBUTOR CODE, NAME AND ADDRESS

ǑŠÜ”ŽȢREMARK :
Digitally signed by DS Bharat Petroleum
Corporation Limited
Ǒ‘“ȡȲ€ Date: 2018.12.29
—ȡš”ȯĚȪͧ›™˜€Ȩ”Ⱦšȯ ž“ͧ›ͧ˜ŠȯŒ€ȯ07:06:20 +05:30
ƮȡšȡͫŒ ǑĚޙǕ Šš€ȯ¡è…ȡš‹Ü”ȡ Ǒ‘“ȡȲ€ `”—ȪƠȡ€ȯ¡è…ȡš
DATE On Behalf of Bharat Petroleum Corporation Limited Distributor's Signature With Stamp DATE CONSUMER SIGNATURE

ǑŠÜ”ŽȢ€Ǚ”™ȡĤ˜ȡŽ”ğȡ˜ǕəǓ“‘ȶžɉ€ȯͧ›fͪ”†›ȡĤ菑ɅȯNOTE : For certification and important Instruction please see overleaf.