IBP gas form

1 ibp gas FRANCHISE Types of Franchise :-Cylinder FranchiseAuto LPG FranchiseINDO BRIGHT PETROLEUM PVT. czkbV isV ksfy;e izk- fy-Dealership Retail OutletReg. of the Firm(applied for)Registration of interest for setting up ibp gas of applicant:Father :Nationality:Name of the firm(applied for) for communication:District:Pin Code: Contact Nos.:Residence with (STD) code:Office with (STD) code:Office with (STD) code:Mobile:E-mail Id:(Please provide name and contact nos. of a person to be contacted in your absence) person name:Residence with (STD) code:Office with (STD) code:Office with (STD) code:Mobile:Photographof ApplicantPhotographof OCCUPATION/BUSINESS occupation (If individual) source of income(if individual) business (If firm) of the firm/s (If existing) of firm:ProprietorshipPartnershipPublic of the of employees employed:INDO BRIGHT PETROLEUM PVT.

2 This proposal be your primary /additional source of income?:Primary sourceAdditional previous experience inpetroleum industry?:YesNo(If yes, please attach separate sheetto provide more details with respect to experience) family members involved in the petroleum business?(If yes, please attach a separate sheet to provide more details) dealing in retail petroleum businessplease provide following informationof your dealership License ) Lic. No. of the firm:b) Name of the company:c) Name of the dealership & address:d) Operating since:e) Sales volume per annum (Product-wise):Domestic LPGC ommercial available for development:YesNo(If yes, please provide the following detailsA) Site/Location addressSurvey no.

3 Of the plot:Plot/Property addressVillageTalukaDistrictStateNationa l Highway Highway District Road Road SITE OIL INDUSTRY EXPERIENCE IF ANYR egistration BRIGHT PETROLEUM PVT. )Site dimensions :Size of site [Length and Width (Mtrs.)]:Frontage of site (Mtrs.):Length of plot along the road:Total land of plot along the road:Total land areas (Sqr. Mtrs.):Site plan (Please attach a sketch of the plot showing dimensions of the plot and also of the roadon which the plot is situated)Please attach photographs of land / surrounding areaC)Site within/ outside city limits:Distance from nearest city/town:Registration BRIGHT PETROLEUM PVT.

4 OTHER SITE LANDMARK FOR THE of nearest Km stonefrom the plot (Mtrs.) of the Km stone:Same side of the plotorOpp. Side of the plotAndLHS with respect to plotorRHS with respect to on the Km road of the land owner:What is your relationshipwith the owner? all documents relating to the property clear?:YesNo(attach copies of all documents) you willing to give the land/property on long term lease to IBPL:Yes No(In case of Auto LPG) of land:AgriculturalNot Agricultural(If agricultural, indicate time toconvert for non agricultural use) power connection readily available?:YesNo(If no, indicate time requiredto get the power connection):{in case of Auto LPG} there any electrical wirepassing over your site:YesNoif yes:High Tension(HT)Low Tension(LT) water connection available readily?

5 :YesNo (If no, indicate time requiredto get the water supply):(in case of Auto LPG) motorable approach roads toyour land/property existing?:YesNo(If no, what is the planfor development): Registration BRIGHT PETROLEUM PVT. ESTIMATED SALES AND potential of sale fromproposed site:Domestic is your expectation of earning per month from the dealership?(Make a rough calculation of your earnings using industry margins and prices and for the services you propose to offer)Sales of Auto LPG:Servicing of vehicles:Selling tyres, tubes, batteries:Spare tyres:Medicines:Food joint/Dhaba:Consumer goods:Communication centre:(STD / ISD / Internet):Fertilizers / Pesticides:Any other:(Please list details product-wise):(only for Auto LPG) INVESTMENT amount you are willing toinvest in the retail outlet business:Rs.

6 5 to 25 lakhsRs. 25 to 50 lakhsRs. 50 to 100 lakhsMore than Rs. 100 of fund:Own funds BRIGHT PETROLEUM PVT. LTD.(Please mention the documents you will be attaching with the completed form) and data asked for in this form is purely to evaluate your "Expression Of interest" (EOI) for puttingup a retail outlet for of this form does not guarantee award of not complete in all respects may be agree with the above terms and declare on solemn affirmation that IShall follow and accept all terms and conditions given by the company, I also declare that I shall do my level best to complete the target for supply of goods within prescribed time by the company.

7 I agree with the term of non-refunding of Registration amount Rupees forty thousand Only once the processing has been above application and declaration is true to my knowledge and submit the following documents along with application :1) Identitiy Proof of the applicant and partner if any ( PAN Card / Voter ID)2) Address proof of the applicant and partner if any (Ration card / Election Card / DL )3) 3 Photograph of applicant and partner if any should be affixed on to the form4) Blank Stamp Paper of Rs. 500/-5) Cash / DD of Rs. 40000/-Applicant's SignaturePartner's SignaturePhotographPhotographDECLARATION