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2026
Form 4
Mandate for Non-Aadhaar based LPG Subsidy Transfer
(To be submitted to LPG distributor)
To,
Distributor: SRI MUNUSWAMY GAS AGENCY District: CHENNAI, T.N. State: Tamil Nadu
Oil Co: BPC
Sub: Authorization to update my Bank Account details for receiving LPG Subsidy through NEFT/NACH
I hereby affirm that I have only one subsidized LPG connection. I also affirm that I do not possess an Aadhaar Number and confirm my choice to
opt for payment of amounts due to me towards LPG Permanent Advance and Refill Subsidy through NEFT/NACH to my bank account. I authorize
my OMC to seek confirmation of my bank/Aadhaar details from my bank and also authorize my bank to release details of my bank account
(number, name, address, Aadhaar number, moble number etc.) to my OMC for purpose of this scheme. My LPG connection and bank account
details are as under:
PART A: LPG CONNECTION DETAILS (attach copy of Cash Memo or DGCC book or certificate from Distributor/OMC)
LPG Consumer No
53114070
17 digital LPG ID
S KARTHIKEYAN
Mobile No.#
+918681916959
#Pl provide mobile no. in case you do not have a mobile no. you can give the mobile no. of any of your family member.Pl. note that the mobile
no. provided by you will be updated in the LPG database and will overwrite the earlier mobile no. if any.
PART B: PARTICULARS OF MY BANK ACCOUNT (attach copy of passbook or cancelled cheque)
Consumer Name as it appears in his/her Bank Account
KARTHIKEYAN S
00041050315176
HDFC0000004
Received Non Aadhaar Cash Transfer mandate Form 4 from S KARTHIKEYAN, Con. No 53114070 along with copy of passbook/cancelled
cheque.
Date: