#### seemran

- Registration Amount
- Upload Document
- Application Form
- Licence Amount
- LOI File Upload
- Security Amount
- Agreement Copy
- Licence Issued
- GST Document

##### Serial No.

##### Year

##### Fuel Storage Capacity

2 Kilo Litre 3 Kilo Litre 4 Kilo Litre 6 Kilo Litre

### Details of Application 1

##### Name

##### S/o, W/o, C/o

##### Peramnent Address

##### State

##### District

##### Block

##### Pincode

##### Gender

##### Date of Birth

##### Are you the citizen of India

##### Martial Status

- Single
- Married
- Divorced
- Widow(er)

##### Qualification

##### Mobile

##### Email

### Details of Application 2

##### Name

##### S/o, W/o, C/o

##### Peramnent Address

##### State

##### District

##### Block

##### Pincode

##### Gender

##### Date of Birth

##### Are you the citizen of India

##### Martial Status

- Single
- Married
- Divorced
- Widow(er)

##### Qualification

##### Mobile

##### Email

### Upload Photo

#### Passport Size Photo of the Applicant 1

#### Passport Size Photo of the Applicant 2

### Present Occupation / Profession

##### Firm Name

##### Firm Type

- Proprietorship
- Partnership
- Private Ltd. Co
- Public Ltd. Co.

##### Total Turnover

##### Total Employees

##### Is this your main source of income or additional?

Primary Additional

### Assets Details

##### Do you reside in owned house, inherited or rented??

Owned Inherited Rented

##### Have you invested in share market, insurance or any other investment institution?

Yes No

##### Have you taken any kind of loan which is still outstanding?

Yes No

### Enclosed Certified Copy

##### Select Document Type

- Adhaar Card
- Pan Card
- Driving License
- Bank Statement
- ITR
- Electricity Bill
- GST
- other

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