| SL. NO. |
TIME |
SHOPKEEPER NAME & ADDRESS |
MOBILE NO. |
USING LPG Y/N? IF YES, COMM. OR DOM.? |
IF COMM |
QTY. USED EVERY MTH.? |
IF DOM. DO YOU KNOW DOM.CYL. IN COMM. USE IS AN OFFENCE? Y/N? |
IF YES, THEN WHY USING DOM.? |
DO YOU KNOW ABOUT PLL? Y/N? |
IF YES, SOURCE OF INFORMA-TION? |
CONN. REQ.? (Can use for comm. also) Y/N? |
IF NO, WHY? |
| IN |
OUT |
NAME OF COMP |
RATE |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
14 |
15 |
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