“Specimen- This draft is only to take language for
the purpose by Associate/consultant/company.”

Forwarding Letter on Plain paper by Applicant
enclosing Application Form with documents

The Director Marketing,
Premier LPG Limited,
242, D-21 Corporate Park,
Sector-21 Dwarka
New Delhi-110077

Sub.:- Application Form as Distributor/Dealer/Retailer/Dealer(Auto LPG) Cat-I/II/III(as the case may be).


I/We ______________ S/o Shri __________________ R/o _____________________ _______________________________Proprietor / Partner / Authorized Signatory of M/s________________________________________________________________________

authorized vide Resolution dated_________________hereby submitting my/our Application Form along with documents mentioned in the Applications Form for your kind consideration for Distributor/Dealer/Retailer/Dealer(Auto LPG) Cat-I/II/III (as the case may be). In this connections, we are also depositing Rs. 1100/- (Rupees one thousand one hundred only) as Processing Fee (non-refundable) and Rs. 10,000/- (Rupees Ten thousand only) as visiting charges (Non refundable but adjustable) vide D.D No._________________dated _______________drawn on _______________(Name of the Bank)__________________ /RTGS in Company’s account.

Kindly process our application for further action under intimation to the undersigned.

Thanking you,
Your Sincerely,

(       Name     )