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fields marked * are mandatory

State *

Locations *

Salutation *

First Name *

Middle Name

Last Name *

Communication Address

Address Line 1 *

Address Line 2 *

Address Line 3

City *

District *

State *

Pincode *

Contact Number

Landline Number with STD Code *

Email Id *

Occupation *

Brief Details of Occupation

Details of land owned by you to set up LNG Station

Plot No/Survey No/Khasra No/TP No *

Road:National Highway with NO / State Highway with NO / City Road/ Village Road *

Near Land Mark *

Road Going Towards *

Name of City *

Name of Tehsil/District *

Name of State *

Pin Code *

Plot Type *

Non-Agriculture
Agriculture

Plot Size(In Square Meter) *

Photographs of Land

Front View Photo *

Left Side Entry of the Plot *

Right Side Exit of the Plot *

Inside out View of the Plot *

Plot co-ordinates

Latitude

Longtitude

Name of Nearest Petrol Pump from the land

Name of filling Station *

Distance from Land(In KM) *

Any Previous experience in Petroleum Industry *

Yes
No

Proposed Entity if Dealership is awarded *

Proprietorship
Partnership

How did you come to know about Adani Gas (DODO Format) LNG Stations *

I allow Adani Gas Limited to send alerts via SMS on mobile number & Email ID as given in the above inquiry form.

The Details given above by me does not bind Adani Gas Limited to offer or give dealership for LNG Station

I agree to pay a Non-refundable fees of Rs.2000/- for enquiry form fees DODO dealership.

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Fitting Date
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Name of Nearest Petrol Pump from the land

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