New Commercial Connection Request
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Connection Type
Personal & Owner Information
Title
MR
MRS
MISS
Contact Person Name
Name of Owner
Owner's Aadhar No.
Mobile Number (OTP Verification)
+91
WhatsApp Number
+91
Landline Number
Official Email ID
Business & Statutory Details
Name of Outlet
FSSAI No./License no.
Shop Establishment No.
PAN No.
GST No.
Connection Details
Connection For
Select Connection For
Hotel
Restaurant
Canteen
Mess
Lodge
Religious place
Hospitals
Others
Unit Name
Unit Address
Location
Select Location
Panjim
Ponda
Old Goa
Kundaim
Madkaim
Other
If Other, Exact Details
Taluka
Select Taluka
Sattari
Ponda
Tiswadi
Bicholim
Bardez
Pernem
District
Select District
South Goa
North Goa
Fuel & Pipeline Details
Current Fuel
Select Current Fuel
LPG
Electric
Monthly Fuel Consumption (Kg/Litre)
Name of OMC
Select OMC
Indane
Bharat
GO Gas
HP
Total
Others
Name Of Distributor
Distributor Address
Connection No
Nearby Visibility of GNGPL Pipeline
Select Option
Yes
No
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