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Apply For (Adani CNG Gas Station / EV Station)
Personal Details
Salutation
*
Mr.
Mrs.
Ms.
First Name *
Midal Name *
Last Name *
Passport Size Photo*
Aadhar Number *
PAN Number *
Communication Address
Address Line 1 *
Address Line 2 *
Address Line 3 *
State *
City *
Pincode *
Contacts
Landline Number with STD Code
occupation
Select
Agriculture
Business
self-Employed
Other
Brief Details Of Occupation *
Phone Number *
Email *
Details of Land to set up CNG Station
State
Select
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Goa
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal
Andaman and Nicobar Islands
Chandigarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Lakshadweep
Puducherry
Name ofCity *
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 *
Plot Type
Non-Agriculture
Agriculture
Status Of the Land
Owned
Least
Plot Size(In Square Meter)
Photographs of Land
Front View Photo
Right Side Exit of the Plot
Left Side Entry of the Plot*
Inside out View of the Plot
Plot Google 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
Other
How did you come to know about Adani Gas (DODO Format) CNG Stations
select
Adani Total gas Website
Advertisement
Common Friend
News Paper
Social Media
Other
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 CNG Station
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