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


(on letterhead of company/associate authorizing the
person as Customer representative)

(Authorization for customer representative if company)

To whom it may concern

Certified that M/s (name of the concerned/company with address) through Shri _____________,proprietor/partner/authorized signatory of the firm under the One person company (proprietorship)/Limited Lability Partnership/Private Limited/Limited, vide resolution dated_______, whose signatures are attested below is our authorized ‘Customer Representative’ for the areas ___________________. He will get LPG cylinders against the delivery challan/invoice from our                   (plant/godown address or vehicle no.)           in his vehicle for supply to mini retailers and customers of the company in the areas mentioned above. He will also return the empty gas cylinders in the evening to the above plant/godown/vehicle duly acknowledged by the godown keeper/vehicle driver.

He is further authorized to appoint any other person(s) on his behalf for taking/returning delivery of the products under his signatures as per guidelines/terms & conditions of the company.

Signature of ‘Customer Representative’
Authorized Representative of the
company authorizing the person
(Name:                               )
Authorized Representative of the company authorizing the person