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Connection Type
Personal Information
Title
MR
MRS
MISS
Contact Person Name
Mobile Number
+91
WhatsApp Number
+91
Landline Number
Email ID
Connection Details
Connection For
Select Connection For
Hotel
Restaurant
Canteen
Mess
Lodge
Religious place
Hospitals
Unit Name
Unit Address
Location
Select Location
Panaji
Ponda
Old Goa
Kundaim
Madkaim
Taluka
Select Taluka
Sattari
Ponda
Tiswadi
Bicholim
Bardez
Pernem
District
Select District
South Goa
North Goa
Current Fuel
Select Current Fuel
LPG
Electric
Monthly Fuel Consumption (Kg/Litre)
Conversion Timeline
Select Timeline
Immediate
Within Month
Within Six Months
Nearby Visibility of GNGPL Pipeline
Select Option
Yes
No
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Submit
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