CCGRF001

APPLICATION FORM
for plots offered to set up a CNG station on Dealer Owned – Dealer Operated (DODO) basis

Latest
Application No. (Office Use): Passport Size
Photograph
with
Application for: …………………………………….. (Specify the name of the city) Specimen
signature on
the
Application form for setting up CNG station photograph

1. Individual/:
a) Name :………………………………………………………………………………………………………….
b) Father’s Name/ Husband’s Name :………………………………………………………………………….
c) Address of communication :………………………………………………………………………………….
……………………………………………………………………………………………………………………..
Tel.No: …………………………………………. E-mail ID: …………………………………….....................
d) Nationality: ………………………………………
e) Date of Birth: ……………………………………

2. Name of the firm :

a) Type of firm: Partnership / Private/ Public limited /Others. (Documents to be submitted)
b) Address of the firm:………………………………………………………………………………………….
……………………………………………………………………………………………………………………..
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(c) Contact no. (Off.) ……………………………………………………………………………………………
(Mobile):……………………………………………………………………………………..………………..
Fax no. : ……………………………………………………………………………………..………………..
Email id : ……………………………………………………………………………………..……………….
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3. Income:
a) Gross income of the firm during last financial year ended 31/03/16…: Rs…………… (attach proof).
b) In case you are an income tax assesse, please furnish PAN No:……………………………………

4. Site details:
a) Name of the owner(s) of the site: …………………………………………………………………………
b) Relationship of land owner with the applicant: …………………………………………………………..
c) Location of the plot: ……………………………………………………………………………………….
d) Address of the plot:………………………………………………………………………………………..
e) City survey no. of plot & Village: ………………………………………………………………………….
f) Area of the plot (In Sq mtrs): ……………………………………………………………………………..
g) Status of the Plot : Agricultural / Non Agricultural
h) Frontage available (In mtrs): ……………………………………………………………………………...
i) Depth of the plot (In mtrs): ………………………………………………………………………………..
j) Zone: ………………………………………………………………………………………………………...
k) Details of the surroundings:
(Indicate approx. distance between the surroundings and plot boundary)
East: ……………………………………………………………………………………………………………...
West: ……………………………………………………………………………………………………………..
South: …………………………………………………………………………………………………………….
North: ………………………………………………………………………..…………………………………...
l) Availability of power connection: (BEST/BSES/TEC/MSEB)
m) Availability of water connection: …………………………………..……………………………………...
n) Encroachments, if any: …………………………………..………………………………………………..
o) Any reservation on the plot: ……………………………………………………………………………
p) Plot comes under CRZ: Yes / No
q) Details of any adjoining roads (main road, service road etc, indicate width of road):
…………………………………..…………………………………………………………………………….
r) Receipt of notice for set-back of the area ……………………………………………………………
s) FSI available: ……………………………..………………………………………………………......
t) Is any path way crossing the land: …………………………………..………………………………......
u) Any high voltage transmission lines: Near by? If yes distance from the plot: ………….. in mtrs.
v) BMC ward / Local Municipality ward: …………………………………………………………………….
w) Nearest police station: …………………………………………………………………………………….
x) Nearest fire station: ………………………………………………………………………………………..
y) Whether title of plot is clear, marketable and Undisputed: …………………………………………….
z) Whether land is on ownership/lease Basis: ……………………………………………………………
In case of lease, name the lessor and validity of lease: ……………………………………………
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5. Previous experience if any in dealing with hazardous goods /Petroleum Products etc. Necessary
documents for experience, financial strength of firm, achievements etc. have to be submitted
separately.
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 CCGRF001

TERMS AND CONDITIONS

After carrying out the detailed techno-commercial survey, MGL at its sole discretion may select the
suitable plots for setting up of CNG station. Once the sites are selected, then the landowner will have
to enter into an agreement with MGL for a period of 10 years. MGL will prefer large plots, having
good vehicular load and is in the close vicinity of gas pipeline.

The following are the terms and conditions that are presently being followed:

1. IN LAND OWNER’S SCOPE

a) All necessary permissions required from all statutory authorities (like Chief Controller of Explosives
(CCOE) – Nagpur and local office, BMC (Building proposal, Factory department, Environment
department etc)/local Municipal office, MMRDA, NMMC, CFO, MPCB, Directorate of Health & Safety,
Police Commissioner, Traffic Police etc.) for setting up of CNG stations are to be arranged by the
landowner.

b) The entire plot has to be developed exclusively for setting up of CNG station only and no other
activity shall be allowed.

c) All civil works such as foundations, canopies, electrical rooms, trenches, driveway, boundary wall,
Sales room, signage, pylon (totem), entry / exit signs, hoardings, lightings etc are in the scope of the
owner. The technical details & design will be provided by the MGL.

d) Power connection under the industrial category up to the site has to be arranged by the owner. All
necessary permissions including deposits, cable charges, connection charges etc as levied by the
Power licensee for obtaining power supply shall be in the scope of the landowner. If the transformer
and other associated electrical equipment are required for supplying power, then the same shall be in
the scope of the land owner.

e) Power cost towards illumination of the station is in the scope of owner (a separate meter will have
to be provided by the land owner).

f) Day to day operations like dispensing and maintaining the CNG outlet (as per standards of MGL)
shall be in the scope of the owner.

g) Security deposit equivalent to 5 days sale has to be submitted in favor of MGL within fortnight of
signing the agreement. The approximate value comes to Rs 10 Lacs, considering 6000 Kgs sales per
day. Based on the actual sales, the security deposit may vary. MGL reserves the right to enhance
security deposit.

h) Telephone facilities, cabin with table, chair etc. for compressor operator has to be provided by
the owner at his own cost.

i) All safety and general hoardings as per MGL design and specifications are to be arranged by
owner.

j) As per the PNGRB “Quality of Service Standards”, the dealer will provide safe and potable
drinking water, free air, clean and functional toilets, consumer complaint box, safety kits, fire
extinguisher and other safety related equipments, shelter for passenger off loaded before refilling of
vehicles on best endeavor basis.
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k) In case of daughter booster station, the light commercial vehicles required for transportation of
CNG cascades will be arranged by the land owner, for which separate mutually agreed charges will
be paid.

2. IN MGL’S SCOPE

MGL will open either mother / online / daughter booster station depending upon the technical
requirements.
a) All the CNG equipments like compressor, dispenser, and cascade will be installed and
commissioned by MGL.

b) All periodic and break down maintenance of CNG equipment will be in the scope of MGL.

c) The cost of power towards running of compressor and dispenser will be reimbursed by MGL (a
separate meter to be provided).

d) Presently MGL is paying Rs. per Kg of gas dispensed to vehicles towards sale, as a
consideration towards the provision of land, utilities, dispensing arrangements and sales margin to
the landowner.

e) MGL will arrange for cash pick-up from your outlet on daily basis through reputed bankers.
Howeverthe cost of pick-up shall be borne by the landowner.

f) Will train the technician / manpower for dispensing.

The above-mentioned scope is subject to change at the discretion of MGL.

UNDERTAKING:-

I do hereby declare that I have read and understood the above mentioned terms and conditions of
MGL and undertake to produce Originals of all the attachments enclosed with this application at the
time of verification, if called for and is aware that in the event I fail to produce the Originals, my
application for dealership will be disqualified.

That, if selected, I undertake that I will deposit an interest free Security deposit as per the policy of
Mahanagar Gas Ltd.

I, hereby certify that the information given above is true to

the best of my knowledge and belief. Any wrong information / suppression of facts will disqualify me
from being considered for the dealership.

Place: Signature:

Date: (Name in block letters):

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FOLLOWING DOCUMENTS* TO BE SUBMITTED along with application form:

Personal

1. Age Proof ( Any educational certificate)

2. Income Proof (IT Return)
3. ID proof (PAN Card)
4. Address proof ( Driving license)

Business

5. Income proof (IT return/Balance sheet)

6. Net worth certificate from CA
7. Shop and establishment certificate

Land/property

8. Property card.
9. Latest sanctioned DP remarks of BMC/local Municipal office.
10. Key architect plan showing dimensions of property.
11. Lease deed.
12. Ownership documents (Title deed showing the ownership of the land)
13. Latest 7/12 extract (should be less than 6 months old).
14. Latest Property assessment receipt and Property Tax Payment receipt.
15. Title clearance certificate and non - encumbrance certificate from a reputed solicitor, if required
16. Land demarcation with road alignment
17. NOC from landlord in case of lease hold land.
18. Partnership deed in case of partnership firm.
19. NA Tax Receipt
20. NoC from MHADA, CIDCO, MIDC, MMRDA as applicable
21. Succession Certificate / Probate of Will from Hon’ble Court, if original Owner was expired
22. Distribution deed ( in case of family distribution)
23. Mutation entry – Ferfar ( if property is purchased /sale /gift /distribution)
24. Power of Attorney ( if required)

*Above documents shall be submitted along with the application form.

Non-submission of above documents will entail rejection of application.