Application Form

Title

Advertisement Information of Adani CNG Pump Dealership in -

Location Description

India



Type of RO

Regular

Mode of Selection

Draw of Lots



Application Date

State

All State



Apply As

Individual    Partnership

Retail Outlet Eligibility Criteria for Land

15 X 15 Sq.M. (Mininum Size)

Personal Information

MR/MS/MRS *

Full Name *

Pan Number *

Gender *

Res. Address *

Pincode

State *

District *

Email *

Mobile Number *

Date of Birth *

Select Investment *

Location details

Location of the Land *

Declaration

I, .................... of/son of/wife of Shri .................... hereby confirm that I have been authorized to submit this application on behalf of M/s .................... and the information given above is true and correct. Any wrong information/misrepresentation/suppression of facts will make us ineligible for this Dealership. That if any information/declaration given by us in application or in any document submitted by us in support of application for award of the dealership shall be found to be untrue or incorrect or false, the Company would be within its rights to withdraw/terminate letter of intent of the dealership (if already appointed) and that we would have no claim, whatsoever, against the Corporation for such withdrawal/termination.