Bharat Petroleum Retail Outlet Notice Advertisement in 2009 in Maharashtra by joj13098

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									                                        HINDUSTAN PETROLEUM CORPORATION LIMITED
                                                                                                          (A Government of India Enterprise)

                                                                         NOTICE FOR APPOINTMENT OF RETAIL OUTLET DEALERS
  1. Hindustan Petroleum Corporation Limited proposes to appoint dealers for Retail Outlet dealerships in the State of Maharashtra at the following Locations :
Sr.                                                Location                                                   Revenue         Category    Proposed to    Proposed to        Mkt Plan        Estimated      Minimum plot size           Estimated       Amount of     Name of
No.                                                                                                            District                  be developed    be developed                          Sales           in metres              investment        Security     NH /SH
                                                                                                                                         on Company      on Company                          Potential                              required from       Deposit     in case of
                                                                                                                                         leased basis,   owned basis,                          of the                             applicant Rs (lacs), (Rs. lacs) Retail Outlets
                                                                                                                                           refer note     refer note                         site in KL                                excluding                   on Highway
                                                                                                                                           (ii) below     (iii) below                       per month.                                cost of land
 A                                                                 B                                             C              D              E              F               G                 H                   I                      J               K              L
                                                                                                                                                                                                          Area   Frontage Depth
 1    Right hand side upto 1 km from Bhosri junction on Bhosri to Alandi road                               PUNE               OP              -             YES            2005-06            300         676     26        26            20              3
 2    Right hand side on Pune Nasik highway NH-50 Km stone 82 to 84                                         PUNE              OP-W             -             YES            2005-06            300        1800     40        45            20              3         NH-50
 3    Between Sai Corner to Rathanegaon village                                                             PUNE               DEF             -             YES            2005-06            300         676     26        26            20              3
 4    Within 2 Kms from Ottur village on Ottur- Naryangaon road                                             PUNE               OP              -             YES            2009-10            130        1620     36        45            10              2
 5    Left hand side from Talegaon MIDC junction on Talegaon MIDC road at Ambi village                      PUNE               OP              -             YES            2005-06            300        1800     40        45            20              3
 6    Left hand side on Mumbai Pune Highway NH-4 From Kamseth to Somatane Phata                             PUNE               OP              -             YES            2005-06            300        1800     40        45            20              3          NH-4
 7    Paud Road 4 Km from Octroi Naka outside octroi limit                                                  PUNE               OP              -             YES            2005-06            300        1800     40        45            20              3         SH-60
 8    Warale village , Tal Maval                                                                            PUNE              OP-W             -             YES           2005-06 R           130        1440     40        36            20              2
 9    Right hand side from Kaspte Wasti to Golden Cascade Society on Wakad Road                             PUNE               OP              -             YES            2005-06            250         676     26        26            20              3
10    Kalewadi Phata to Kalewadi                                                                            PUNE               PMP             -             YES            2005-06            300        1800     40        45            20              3
 11   Left hand side on SH-60 between Km stone 36 to 38 on Paud Road at Akole Tal. Mulshi                   PUNE               OP              -             YES            2005-06            200        1800     40        45            20              3         SH-60
12    Left hand side from Somatane Phata to Sai Baba Temple on Kasarsai road                                PUNE               OP              -             YES            2005-06            300        1800     40        45            20              3
13    Between Hotel Leroyale to Hotel Cent Laurn on Hinjewadi Man road                                      PUNE               OP              -             YES            2005-06            300         676     26        26            20              3
14    At Pimple Nilakh on Wakad to Baner road                                                               PUNE               OP              -             YES            2005-06            250         676     26        26            20              3
15    Between Km stone 11 To 14 on LHS on Chakan Shikrapur Road SH-55                                       PUNE               OP              -             YES            2005-06            200        1800     40        45            20              3
16    Bhosari, Tal Haveli                                                                                   PUNE               DEF             -             YES            2005-06            200         676     26        26            20              3
17    Pimpri, Tal Haveli                                                                                    PUNE               PMP             -             YES            2005-06            200         676     26        26            20              3
18    Akurdi, Tal Haveli                                                                                    PUNE              DEF-W            -             YES            2005-06            150         676     26        26            20              3
19    Within 4km from Vighnaharta Hospital on LHS from Nagar towards Pune on Shirur Byepass (SH-60)         PUNE               OP              -             YES            2005-06            260        3500     50        70            30              3         SH-60
20    Within 3km from Taishika Engg Pvt Ltd. on LHS from Nagar towards Pune on SH-60                        PUNE               OP              -             YES            2005-06            210        1800     40        45            30              3         SH-60
21    Within 1 To 4 Km Stretch from Shikrapur Square on Shikrapur -Pabal road                               PUNE                OP             -             YES            2009-10             75        1620     36        45            10              2
22    Within 1 To 3Km on NH-4 from Nasrapur Phata on RHS towards Satara from Pune.                          PUNE               OP              -             YES            2005-06            260        1800     40        45            30              3          NH-4
23    Within 2 Km from Km Stone "Shikrapur 8km" towards Shikrapur on Chakan Shikrapur road                  PUNE               OP              -             YES            2009-10             55        1620     36        45            10              2         SH-55
24    Pune Satara road from Swargate Bus Stand upto Citypride Cinema On RHS                                 PUNE               OP              -             YES            2005-06            200         676     26        26            20              3
25    Takli Haji, Tal Shirur                                                                                PUNE              OP-W             -             YES            2009-10             65        1620     36        45            10              2
26    Within 1 To 4 Km on SH-65 from the Junction of NH-4 & SH-65                                           PUNE               OP              -             YES            2009-10             65        1620     36        45            10              2         SH-65
27    Stretch from Bharat Forge to Ghorpadi Police Station                                                  PUNE               OP              -             YES            2005-06            170         676     26        26            20              3
28    From Katraj Bus Stand to Kondhwa Village on Katraj Kondhwa road                                       PUNE               OP              -             YES            2005-06            210         676     26        26            20              3
29    From Bund Garden Bridge to Viman Nagar on Nagar road                                                  PUNE               OP              -             YES            2005-06            200         676     26        26            20              3
30    From Bund Garden Bridge to Visharantwadi on Alandi road (MDR 48)                                      PUNE               OP              -             YES            2005-06            200         676     26        26            20              3        MDR 48
31    LHS within 4km on Pune Nagar Road from Km Stone "Lonikand 2km" towards Nagar ( SH-60)                 PUNE               OP              -             YES            2005-06            260        1800     40        45            30              3         SH-60
32    LHS on SH-60 from Nagar towards Pune within 6km from Km stone "Karegaon 4km"                          PUNE               OP              -             YES            2005-06            210        1800     40        45            30              3         SH-60
33    On RHS from Pune to Nagar on SH-60 within Km stone "Shikrapur 3km" to "Shikrapur 1 Km"                PUNE              OP-W             -             YES            2005-06            230        1800     40        45            30              3         SH-60
34    Lullanagar square to Bibwewadi Triangle on either side                                                PUNE              OP-W             -             YES            2005-06            200         676     26        26            20              3
35    Within 2km from Vishrantwadi towards Alandi on MDR 48                                                 PUNE              OP-W             -             YES            2005-06            200         676     26        26            20              3        MDR-48
36    Lohgaon on MDR 55 within 4km from Lohgaon Bus Stand towards Wagholi                                   PUNE              OP-W             -             YES            2009-10             60        1620     36        45            10              2        MDR-55
37    NIBM road                                                                                             PUNE               OP              -             YES            2005-06            200         676     26        26            20              3
38    Mundhwa, Tah. Haveli                                                                                  PUNE              OP-W             -             YES            2005-06            200         676     26        26            20              3
39    Fatima Nagar signal upto Wanowrie Circle                                                              PUNE              OP-W             -             YES            2005-06            200         676     26        26            20              3
40    On Pandharpur Mahad road (SH-70) within 3km from Km Stone "Pandharpur - 190 Km" towards
      Pandharpur, Dist. Pune, Taluka. Bhor                                                                  PUNE               OP              -             YES            2009-10             50        1620     36        45            10              2         SH-70
41    Within 1 to 4km from Khedshivapur Toll Naka on NH-4 towards Satara on LHS                             PUNE               OP              -             YES            2005-06            250        3500     50        70            30              3          NH-4
42    LHS on Pune Satara road (NH4) towards Satara within 3km from Km Stone " Kolhapur 190km" Dist Pune     PUNE               OP              -             YES            2005-06            230        1800     40        45            30              3          NH-4
43    Nimone on SH-62                                                                                       PUNE               DEF             -            YES             2009-10             50        1620     36        45            10              2         SH-62
44    Within 1 To 4km from Khedshivapur Toll Naka on LHS on NH4 towards Pune                                PUNE              OP-W             -            YES             2005-06            230        1800     40        45            30              3
45    Within the stretch from Chhatrapati Shahu Maharaj Bank - Dhankawadi Police Station-
      Taljai Pathar - Market Yard square                                                                    PUNE              OP-W             -            YES             2005-06            190         676     26        26            20              3
46    Dandekar Bridge to Alka Talkies                                                                       PUNE               OP              -            YES             2005-06            190         676     26        26            20              3
47    Within 4km from Dandekar Bridge towards Sinhagad on Sinhagad road                                     PUNE               OP              -            YES             2005-06            210         676     26        26           20               3
48    Within 6 Km from Katraj Bus Stand on Mumbai -Bangalore byepass towards NH-4                           PUNE              OP-W             -            YES             2005-06            180         676     26        26           20               3
49    Laxmi road                                                                                            PUNE              PH-W             -            YES             2005-06            200         676     26        26           20               3
50    Shivapur Village on SH-51                                                                             PUNE               OP              -            YES             2009-10             50        1620     36        45           10               2         SH-51
51    Shankarshet Road                                                                                      PUNE              PH-W             -            YES             2005-06            200         676     26        26           20               3
52    Katraj Bus Stand within 3km towards Satara on old NH-4                                                PUNE               PMP             -            YES             2005-06            200         676     26        26           20               3
53    Lullanagar Square to Bhairoba Nala                                                                    PUNE             DEF-W             -            YES             2005-06            180         676     26        26           20               3
54    Bhawani Peth                                                                                          PUNE             DEF-W             -            YES             2005-06            180         676     26        26           20               3
55    Citypride Cinema to Katraj Bus Stand on RHS                                                           PUNE             OSP-W             -            YES             2005-06            180         676     26        26           20               3
56    Market Yard, Pune                                                                                     PUNE             PMP-W             -            YES             2005-06            170         676     26        26           20               3
57    Bibwewadi, Pune                                                                                       PUNE              FF-W             -            YES             2005-06            170         676     26        26           20               3
58    Warje Village, Tal Haveli                                                                             PUNE               PH              -            YES             2009-10             50        1620     36        45           10               2
59    LHS on Jejuri Saswad Rd (on SH-64) Between Km St 23 to 25 towards Saswad                              PUNE              OP-W             -            YES             2009-10            140        1620     36        45           10               2         SH-64
60    Saswad - Bhor Rd (SH-63) from Bhiwadi Village to Narayanpur Datta Mandir                              PUNE              OP-W             -            YES             2009-10            100        1620     36        45           10               2         SH-63
61    LHS Between Km Stone 34 to 36 while travelling towards Saswad from Jejuri on SH-64                    PUNE               OP              -            YES             2009-10            150        1620     36        45           10               2         SH-64
62    From main entrance of Morgaon Ganpati Temple upto 1 Km towards Jejuri on LHS on
      Morgaon-Jejuri Rd ( SH-65)                                                                            PUNE               OP              -            YES             2009-10            120        1620     36        45           10               2         SH-65
63    LHS on Jejuri - Morgaon Rd (SH-65) within 2 Kms from end of Rly Overbridge towards Morgaon            PUNE             DEF-W             -            YES             2009-10            100        1620     36        45           10               2         SH-65
64    Kalamb Village - within 1/2 Km on either side of Natepute Chowk on BKBN Rd (MDR 72)                   PUNE               OP              -            YES             2009-10             70        1620     36        45           10               2        MDR-72
65    Natepute On LHS between Km Stone 172 To 173 towards Malshiras On Phaltan - Pandharpur Rd (SH-70)      SOLAPUR           OP-W             -            YES             2009-10            150        1620     36        45           10               2         SH-70
66    Village Korhale Budruk on LHS of Baramati- Nira Rd (SH-66)                                            PUNE               OP              -            YES             2009-10            100        1620     36        45           10               2         SH-66
67    LHS on Bhigwan - Baramati Rd towards Baramati within 1 to 4 Km. from junction of NH-9 & SH-68         PUNE              PH-W             -            YES             2009-10            110        1620     36        45           10               2         SH-68
68    Lingali Village on Daund-Kurkumbh Rd (SH-10)                                                          PUNE               OP              -            YES             2009-10            140        1620     36        45           10               2         SH-10
69    Pargaon on LHS Choufula-Shirur Highway (SH-62)                                                        PUNE               OP              -            YES             2009-10            100        1620     36        45           10               2         SH-62
70    Manjeri Village from Hadapsar towards Manjeri Rly Crossing (1/2 Km before Rly Crossing)               PUNE               OP              -            YES             2005-06            150         676     26        26           20               2
71    Hadapsar Gaon,Sasane Nagar                                                                            PUNE               OP              -            YES             2005-06            150         676     26        26           20               2
72    From Sasane Nagar Rly. Phatak to Corrianthan Club, Undri-on Mohammedwadi Rd.                          PUNE              OP-W             -            YES             2005-06            140         676     26        26           20               2
73    Baramati - Indapur Rd (SH-66) LHS within 5 Kms from Baramati but beyond 1 Km on either side
      of Toll Naka towards Indapur                                                                          PUNE                OP             -            YES             2009-10            140        1620     36        45           10               2         SH-66
74    Veer Village Taluka Purandar                                                                          PUNE              PMP-W            -            YES             2009-10             75        1620     36        45           10               2
75    LHS on Nira - Jejuri Rd within 3 Km from Nira on SH-61                                                PUNE                OP             -            YES             2009-10             80        1620     36        45           10               2         SH-61
76    On LHS of Bhigwan - Rashin Rd towards Rashin within 1 to 4 Km. from junction of NH-9 & SH-68          PUNE               OP              -            YES             2009-10            100        1620     36        45           10               2         SH-68
77    On Baramati - Gunewadi Rd within 1 Km of Baramati on MDR 72                                           PUNE               OP              -            YES             2009-10            150        1620     36        45           10               2        MDR-72
78    On LHS on Malshiras - Natepute Rd (SH-70), within 2 Kms from Malshiras Chowk                          SOLAPUR           OP-W             -            YES             2009-10            100        1620     36        45           10               2         SH-70
79    Osmanabad City- on Osmanabad Barshi road, on SH-67, 1/2 Km from Barshi Naka
      on left side towards Barshi.                                                                          OSMANABAD          OP              -            YES             2009-10            110        1620     36        45           20               2         SH-67
80    On Tuljapur to Naldurg road (SH-153) between Kms stone 49 to 55                                       OSMANABAD         OP-W             -            YES             2009-10             90        1620     36        45           10               2         SH-153
81    On Tuljapur Akkalkot road between Nanduri & Mangrul Village on SH-154                                 OSMANABAD           OP             -            YES             2009-10             90        1620     36        45           10               2         SH-154
82    On SH-151 at Village Dudhani within 1 Km on either side of ST Stand                                   SOLAPUR            OP              -            YES             2009-10             70        1620     36        45           10               2         SH-151
83    On SH-151 from Akkalkot to Maindargi road between Km stone 118 to 119                                 SOLAPUR            OP              -            YES             2009-10             70        1620     36        45           10               2         SH-151
84    On SH-3 between Tirhe to Kamti villages                                                               SOLAPUR           OP-W             -            YES             2009-10             90        1620     36        45           10               2          SH-3
85    On Pandharpur Sangola road, SH-161 between Km stone 15 & 16 at village Khardi.                        SOLAPUR             OP             -            YES             2009-10             90        1620     36        45           10               2         SH-161
86    Within 2 Km distance from Degaon Octroi Naka towards Kamti on SH-3 on either side of the road         SOLAPUR           OP-W             -            YES             2009-10             80        1620     36        45           10               2          SH-3
87    On Atpadi road 1 Km from Nazre Gaon towards Nazre Math. Tal Sangola Dist. Solapur                     SOLAPUR            OP              -            YES             2009-10             50        1620     36        45           10               2
88    On Sangola Jat road Upto 2 Kms from Kadlas village Tal. Sangola Dist. Solapur                         SOLAPUR            OP              -            YES             2009-10             50        1620     36        45           10               2
89    Makni - Sastur road Upto 1 Km from Makni Chourasta in taluka Lohara                                   OSMANABAD         OP-W             -            YES             2009-10             90        1620     36        45           10               2
90    Kalamb Diskal road on SH-159 between Tuljabhavani Dudh Utpadak Sangh & Sharad Fabrication Works                         OP-W             -            YES             2009-10             80        1620     36        45           10               2         SH-159
      on RHS from Kalamb to Diskal                                                                          OSMANABAD
91    On SH-141 Mangalvedha Pandharpur road from Mangalvedha ST Stand to PWD Rest House on RHS              SOLAPUR            OP              -            YES             2009-10             90        1620     36        45           10               2         SH-141
92    Machnur/brahmapuri to Mangalvedha on SH-3 on LHS between Km stone 330 to 328                          SOLAPUR            OP              -            YES             2009-10             85        1620     36        45           10               2          SH-3
93    Madha Kurduwadi road on SH-149 between Km stones 11 & 12                                              SOLAPUR             OP             -            YES             2009-10             60        1620     36        45           10               2         SH-149
94    Sangola Miraj road on SH-3 between Km stone 280 to 281                                                SOLAPUR            OP              -            YES             2009-10             60        1620     36        45           10               2          SH-3
95    On Sangola Pandharpur road, SH-161 between Km stone 31 to 30                                          SOLAPUR            OP              -            YES             2009-10            120        1620     36        45           10               2         SH-161
96    On Mandrup Basavnagar road SH-149 on LHS from Mandrup towards Basavnagar                              SOLAPUR            OP              -            YES             2005-06            575        3500     50        70           30               5         SH-149
97    Sangola Town - on left hand side between the stretch Kadlas Naka to ST Stand.                         SOLAPUR            OP              -            YES             2005-06            300        3500     50        70           30               3          SH-3
98    On Pune Solapur road on NH-9 between Km stone 207 to 208 on RHS from Pune towards Solapur             SOLAPUR            OP              -            YES             2005-06            290        3500     50        70           30               3          NH-9
99    On Solapur Hyderabad road on NH-9 between Km stone 334 to 337                                         OSMANABAD          OP              -            YES             2005-06            240        3500     50        70           30               3          NH-9
100   Pandharpur City- on LHS from Krantisinha Nana Patil Chowk to Ujani Colony                             SOLAPUR           OP-W             -            YES             2005-06            225         676     26        26           20               3
101   Solapur WML- from Gentyal Theatre to Akashwani                                                        SOLAPUR            OP              -            YES             2005-06            150         676     26        26           20               3
102   On Mohol-Barshi road at village Malvandi upto 1 Km from ST Stand                                      SOLAPUR            OP              -            YES             2009-10             60        1620     36        45           10               2
103   Barshi town old railway gate at Sulakhe High School to old railway gate at Shivaji College            SOLAPUR            OP              -            YES             2005-06            150        676      26        26           20               2
Categories - OP : Open, OP(W) : Open for Women only, PH : Physically Handicapped, DEF : Defence Personnel, DEF(W) : Defence Personnel for Women only, FF : Freedom Fighter OSP : Outstanding Sports Persons, PMP : Paramilitary/Police/Government Personnel     (Contd. on page 2)
                                                HINDUSTAN PETROLEUM CORPORATION LIMITED
                                                                                                                             (A Government of India Enterprise)

                                                                                    NOTICE FOR APPOINTMENT OF RETAIL OUTLET DEALERS
(Page 2, continued from Page 1)

       Sr.                                                   Location                                                              Revenue     Category      Proposed to Proposed to             Mkt Plan     Estimated Sales Potential          Approximate plot size             Estimated       Amount of     Name of
       No.                                                                                                                          District                be developed be developed                                    of                           in metres                   investment        Security     NH /SH
                                                                                                                                                            on Company on Company                               MS     HSD      TMF                                             required from       Deposit     in case of
                                                                                                                                                            leased basis, owned basis,                                                                                        applicant Rs (lacs), (Rs. lacs) Retail Outlets
                                                                                                                                                              refer note   refer note                                                                                              excluding                   on Highway
                                                                                                                                                              (ii) below   (iii) below                                                                                            cost of land
       A                                                                      B                                                      C              D              E                 F              G                        H                              I                           J                K                L
                                                                                                                                                                                                                                                Area     Frontage Depth
      104    Saidapur-Oglewadi (SH-78)                                                                                        SATARA              OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs        SH-78
      105    Karad(OML) -2 Km from Karve Naka on Karad-Palus road (SH-75)                                                     SATARA              OP               -             YES            2009-10         25           65        90       1620         36         45           10 Lacs           2 Lacs        SH-75
      106    Surwadi-Nimbore on Lonand-Phaltan road(SH-70)                                                                    SATARA            OP- W              -             YES            2009-10         20           80        100      1620         36         45           10 Lacs           2 Lacs        SH-70
      107    Padegaon 4 Km from Nira river towards Satara on SH-61                                                            SATARA              OP               -             YES            2009-10         20           70        90       1620         36         45           10 Lacs           2 Lacs        SH-61
      108    Katarkhatav on SH-10                                                                                             SATARA              OP               -             YES            2009-10         25           70        95       1620         36         45           10 Lacs           2 Lacs        SH-10
      109    Phaltan-4 Km from Nana Patil Chowk on Phaltan-Lonand road(SH-70)                                                 SATARA              OP               -             YES            2009-10         20           80        100      1620         36         45           10 Lacs           2 Lacs        SH-70
      110    Medha on SH-73                                                                                                   SATARA             OP-W              -             YES            2009-10         25           70        95       1620         36         45           10 Lacs           2 Lacs        SH-73
      111    Rahimatpur on SH-73                                                                                              SATARA              OP               -             YES            2009-10         25           70        95       1620         36         45           10 Lacs           2 Lacs        SH-73
      112    Karad-Chiplun road (SH-78)- 2 Km from NH-4 junction (Varunji village) towards Patan                              SATARA              OP               -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs        SH-78
      113    On SH-63, Wai Surur road between Krishna river canal, Shendurjane and Kenjal Phata                               SATARA              PH               -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs        SH-63
      114    On SH-61, Satara to Nira road between Patkhalmatha to Arphal village                                             SATARA              OP               -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs        SH-61
      115    Umbraj- 2 Km from Umbraj town towards Patan On SH-76                                                             SATARA              DC               -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs        SH-76
      116    On SH-73 - 3 Km from NH-4 junction towards Rahimatpur (Kodoli village)                                           SATARA              OP               -             YES            2009-10         25           70        95       1620         36         45           10 Lacs           2 Lacs        SH-73
      117    On NH-4, left hand side from Karad to Pune road between Indoli and Atit( Km No.703 to 713)                       SATARA              OP               -             YES            2009-10         30           250       280      2700         45         60           20 Lacs           5 Lacs        NH-4
      118    On NH-4, right hand side from Satara to Pune road between Pargaon and Shirwal (Km No.783 to 791)                 SATARA              OP               -             YES            2009-10         30           230       260      2700         45         60           20 Lacs           5 Lacs        NH-4
      119    On NH-4, left hand side from Satara to Pune road between Bhuinj and Surur( Km No.757 to 770)                     SATARA            OP- W              -             YES            2009-10         40           230       270      2700         45         60           20 Lacs           5 Lacs        NH-4
      120    On NH-4, right hand side from Kolhapur to Pune road between Kameri and Waghwadi Phata
             ( Km No. 647 to 655)                                                                                             SANGLI              OP               -             YES            2009-10         30           220       250      2700         45         60           20 Lacs           4 Lacs        NH-4
      121    Shiradhon on SH-3                                                                                                SANGLI              OP               -             YES            2009-10         20           55        75       1620         36         45           10 Lacs           2 Lacs        SH-3
      122    Nagaj Phata on SH-3-2 Km towards Sangli (Km No.240 to 242)                                                       SANGLI             PMP               -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs        SH-3
      123    Umdi                                                                                                             SANGLI            OP- W              -             YES            2009-10         20           50        70       1620         36         45           10 Lacs           2 Lacs          SH
      124    Miraj OML on Maishal road(SH-138), from Km No.57 to 60                                                           SANGLI              OP               -             YES            2009-10         40           90        130      1620         36         45           10 Lacs           2 Lacs       SH-138
      125    Bagni on Ashta Vadgaon road (SH-136)                                                                             SANGLI             OSP               -             YES            2009-10         15           60        75       1620         36         45           10 Lacs           2 Lacs       SH-136
      126    Daflapur                                                                                                         SANGLI              DC               -             YES            2009-10         15           60        75       1620         36         45           10 Lacs           2 Lacs       SH-140
      127    Shirala-3 Kms from Govt.rest house towards bus stand on SH-111.                                                  SANGLI              OP               -             YES            2009-10         35           95        130      1620         36         45           10 Lacs           2 Lacs       SH-111
      128    Islampur Chikurde road, between Islampur and Waghwadi Phata (MDR-13)                                             SANGLI              OP               -             YES            2009-10         20           80        100      1620         36         45           10 Lacs           2 Lacs
      129    Kavthemahankal on SH-140                                                                                         SANGLI              OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-140
      130    On SH-75, Sangli-Karad road, Stretch of 2 Km from 5th mile Junction towards Palus                                SANGLI              FF               -             YES            2009-10         20           55        75       1620         36         45           10 Lacs           2 Lacs        SH-75
      131    On SH-10, 2 Km from bypass road junction, Tasgaon Town towards Sangli on SH-10                                   SANGLI              OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs        SH-10
      132    On SH-136, 2 Km from Maharana Pratap Chowk, Tasgaon Town towards Bhivghat                                        SANGLI              OP               -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs       SH-136
      133    Kupwad OML- 2 Km from Municipal Limit on Kupwad Tanang Road(MDR-42)                                              SANGLI              OP               -             YES            2009-10         20           70        90       1620         36         45           10 Lacs           2 Lacs
      134    Satara City                                                                                                      SATARA             DEF               -             YES            Modified        80           110       190      1620         36         45           10 Lacs           2 Lacs
                                                                                                                                                                                                 03-04
      135    Satara OML on Koregaon road(SH-74) upto Krishna river bridge                                                     SATARA              OP               -             YES            Modified        50           150       200      1620         36         45           10 Lacs           2 Lacs        SH-74
                                                                                                                                                                                                05-06 R
      136    Arag, Taluka-Miraj (MDR-44)                                                                                      SANGLI             DEF               -             YES            Modified        20           70        90       1620         36         45           10 Lacs           2 Lacs
                                                                                                                                                                                                05-06 R
      137    Kudal, Tq.Jawli                                                                                                  SATARA              OP               -             YES            Modified        20           60        80       1620         36         45           10 Lacs           2 Lacs
                                                                                                                                                                                                05-06 R
      138    Khanapur On SH-78                                                                                                SANGLI              OP               -             YES            Modified        20           60        80       1620         36         45           10 Lacs           2 Lacs        SH-78
                                                                                                                                                                                                05-06 R
      139    Panchgani-Bhose On SH-72                                                                                         SATARA            OP- W              -             YES            Modified        40           80        120      1620         36         45           10 Lacs           2 Lacs        SH-72
                                                                                                                                                                                                05-06 R
      140    Mhaswad On SH-74                                                                                                 SATARA              OP               -             YES            2009-10         40           60        100      1620         36         45           10 Lacs           2 Lacs        SH-74


      141    Sambhapur On SH 136 Left Hand Side Mile Stone No.2 To 3 Towards Wadgaon From Toap.                               KOLHAPUR            OP               -             YES            2009-10         30           100       130      1620         36         45           10 Lacs           2 Lacs       SH-136
      142    Halkarni-on Halkarni Terni Road On RH Side Towards Terni                                                         KOLHAPUR            OP               -             YES            2009-10         40           60        100      1620         36         45           10 Lacs           2 Lacs
      143    Kapshi                                                                                                           KOLHAPUR            OP               -             YES            2009-10         20           80        100      1620         36         45           10 Lacs           2 Lacs       SH-114
      144    Lingnoor                                                                                                         KOLHAPUR            DC               -             YES            2009-10         20           70        90       1620         36         45           10 Lacs           2 Lacs       SH-114
      145    Pattankodli                                                                                                      KOLHAPUR           OSP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-116
      146    Herle On SH-3 Left Hand Side                                                                                     KOLHAPUR          OP- W              -             YES            2009-10         40           80        120      1620         36         45           10 Lacs           2 Lacs        SH-3
      147    Koparde On SH 210 Left Hand Side                                                                                 KOLHAPUR            OP               -             YES            2009-10         50           100       150      1620         36         45           10 Lacs           2 Lacs       SH-210
      148    Uttur On Uttur Panji Road Left Hand Side On SH 121                                                               KOLHAPUR            OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-121
      149    Murgud On SH 116 Right Side Mile Stone 119/340 To 119/400                                                        KOLHAPUR            OP               -             YES            2009-10         50           150       200      1620         36         45           10 Lacs           3 Lacs       SH-116
      150    Shirol (Nrusinhwadi-Miraj Road)                                                                                  KOLHAPUR           OP-W              -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-137
      151    Sangshi Phata To Gaganbawda On Sh 115 LHS                                                                        KOLHAPUR            OP               -             YES            2009-10         30           100       130      1620         36         45           10 Lacs           2 Lacs       SH-115
      152    Sarwade On Nipani Radhanagari Road                                                                               KOLHAPUR           OP-W              -             YES            2009-10         20           60        80       1620         36         45           10 Lacs           2 Lacs       SH-116
      153    Sangwade On Uchagaon Hupri Road Right Hand Side                                                                  KOLHAPUR            OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-131
      154    Sakharpa By Pass Upto Deorukh Phata LHS                                                                          RATNAGIRI           OP               -             YES            2009-10         50           200       250      1620         36         45           10 Lacs           4 Lacs       SH-204
      155    5 Kms From Sangmeshwar Towards Hathkhamba LHS                                                                    RATNAGIRI           OP               -             YES            2009-10         50           200       250      2700         45         60           10 Lacs           4 Lacs        NH-17
      156    Chiplun Shirgaon Road                                                                                            RATNAGIRI           OP               -             YES            2009-10         40           60        100      1620         36         45           10 Lacs           2 Lacs        SH-78
      157    Khadi-kolwan On SH 111 Oni Pachal Road                                                                           RATNAGIRI           OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-111
      158    Chiplun City On NH 17                                                                                            RATNAGIRI           OP               -             YES            2009-10         50           100       150      2700         45         60           10 Lacs           2 Lacs        NH-17
      159    Lote-Parshuram On NH-17 On RHS                                                                                   RATNAGIRI           OP               -             YES            2009-10         50           100       150      2700         45         60           10 Lacs           2 Lacs        NH-17
      160    Phonda Ghat                                                                                                      SINDHUDURGA         OP               -             YES            2009-10         30           70        100      1620         36         45           10 Lacs           2 Lacs       SH-116
      161    8 Kms From Rajapur Towards Talera Phata On LHS                                                                   RATNAGIRI           OP               -             YES            Modified        50           150       200      2700         45         60           10 Lacs           3 Lacs        NH-17
                                                                                                                                                                                                05-06 R

Note : Locations rostered in SC/SC(W) & ST/ST(W) will be advertised after finalization of land .
Notes:                                                                                                         can also be downloaded from our website www.hindustanpetroleum.com. These                                      not available.
i.       (W) indicated in category means reserved for WOMEN only.                                              guidelines including the application form, all the applicable guidelines on dealer                             Outstanding Sports Persons Category (OSP) :
ii.      The locations indicated as 'YES' under the column 'E' are proposed to be developed on                 selection and the drafts of affidavits/declarations to be submitted along with the                             The following persons will be eligible:
         company leased basis. The superstructures are to be constructed by the applicant & Land               application forms are also available in the form of a Brochure also which can be                               (a) Arjuna Awardees.
                                                                                                               procured at a cost of Rs.50/- from our office at the address mentioned below . All the                         (b) Winners of Medals at Olympics/ Asian /Commonwealth Games and Recognised
         along with the superstructures will be leased by the applicant to HPCL. The reasonable lease
                                                                                                               candidates proposing to apply for dealership for any of the locations mentioned above                              World Champions.
         rental amounts in these cases will be paid to the landlord & the same amount will be recovered
                                                                                                               must access our above mentioned website and/or procure the brochure on dealership                              (c) National Champions under the Recognised National Championships.
         as additional licence fee from the dealership. Beside this, Service Station Licence Fee (SSLF)                                                                                                                       (d) National Adventure Awardees.
         at lower rate will be recovered from dealership, which is presently Rs. 13/- per KL for Petrol &      selection guidelines applicable for advertisements effective 01.04.2009, for complete
                                                                                                               and detailed information on dealer selection.                                                                  Candidates should attach a copy of certificate from the Recognised National Federation
         Rs. 11/- per KL for Diesel.                                                                                                                                                                                          Organising National Championships (as recognised by Department of Youth Affairs and
iii.     The locations indicated as 'YES' under the column 'F' are proposed to be developed on ix.             For locations under Marketing plan 2009-10, the candidates after placement of LOI,
                                                                                                                                                                                                                              Sports, Govt of India) or from the Dept of Youth Affairs and Sports, Govt of India.
         company owned basis. The applicant is required to lease only the land to HPCL.                        would be required to fill the land to the satisfaction of HPCL, upto the plinth level
                                                                                                               including the retaining wall and offer the same to HPCL for setting up the facilities.                         Paramilitary/ Police/ Government Personnel Category (PMP):
         Superstructures on the land will be constructed by HPCL. The lease rental amounts for land in
                                                                                                                                                                                                                              The following persons will be eligible:
         these cases will be paid to the landlord but will not be recovered from the dealership. Service 2.    Eligibility Criteria :
                                                                                                                                                                                                                              The personnel of Paramilitary/Police Personnel including persons having served in
         Station Licence Fee (SSLF) will be recovered at higher rate from dealership, which is presently a.    Applicant should be Indian Nationals (Affidavit to be furnished as per Appendix A & A1                         BSF,CRPF,CISF, ITBP, Railway Protection Force, Special Reserved Police, Special Armed
         Rs. 43/- per KL for Petrol & Rs. 36/- per KL for Diesel.                                              as applicable)                                                                                                 Police, Coast Guards, Assam Rifles etc. as designated by Central Government and Police
iv.      The candidate should furnish along with the application, details of land, which he/she may b.         Category:-                                                                                                     Forces of the States, Customs and Central Excise Department, Narcotics Control Bureau,
         make available for the Retail Outlet. Considering the location of the land from the point of view     While only persons belonging to the following categories can apply against specific locations                  Enforcement Directorate, Economic Intelligence Bureau, Directorate General of Anti-Evasion
         of feasibility and commercial angle and rates acceptable to the company, applicants willing to        reserved /advertised for the respective category, any eligible person can apply against Open                   and Directorate of Revenue Intelligence and those serving in different Departments of
         transfer the land on long lease to HPCL would be given preference. The selected Candidates            category. (Copy of certificate from the competent authority to be furnished as proof of                        Central/State Governments who are incapacitated OR disabled while performing their duties
         will be required to lease the plot of land and superstructure, as defined in sr. no. (ii) above or    belonging to the category as applicable)                                                                       and their widows/ dependants in case of their death while performing duties.
         land as defined in sr. no. (iii) above for a period of minimum 15 years with renewal option for       Scheduled Caste/ Scheduled Tribe Category (SC/ST):                                                             Inter-se priority for PMP category:
         another 15 years.                                                                                     Locations for SC/SC(W) & ST/ST(W) to be advertized after finalization of land.                                 (a) Widows/ dependents of Posthumous gallantry award winners.
v.       If an applicant, after selection, is unable to provide the land indicated by him/her in the           Physically Handicapped Category (PH):                                                                          (b) Widows / dependents of persons having died in action.
         application form within a period of TWO months from the date of Letter of Intent (LOI), the           Persons belonging to this category should be orthopaedically handicapped to the extent of                      (c) Persons disabled on duty.
                                                                                                               minimum of 40% permanent/ partial disability of either upper or lower limbs or 50% permanent/                  (d) Widows / dependants of persons who died while in service
         Corporation will have the right to cancel the allotment of dealership/distributorship made to
                                                                                                               partial disability of both upper and lower limbs together. For this purpose, the standards                     (e) Disabled in peace due to attributable causes
         him/her. The suitability of Land will be decided by HPCL. There is no commitment from HPCL                                                                                                                           Please attach a copy of certificate from the concerned organization/ Govt Department signed
         for taking the offered Land from the applicant.                                                       contained in the `Manual for Orthopaedic Surgeon in evaluating Permanent Physically
                                                                                                               Impairment' brought out by the American Academy of Orthopaedic Surgeons, USA and                               by the Head of Office or an Officer not below the rank of Under Secretary to the Govt.
vi.      The eligible candidates who have readily available site suitable for setting up of Retail Outlet or                                                                                                                  indicating that the applicant belongs to any of the above:
                                                                                                               published on its behalf by the Artificial Limbs Manufacturing Corporation of India, G.T. Road,
         have a firm commitment from the land owner for purchase/lease of site should furnish along                                                                                                                           Freedom Fighter Category (FF):
                                                                                                               Kanpur, shall apply. In this connection the Govt. notification no.154 published on 13.06.2001
         with their application the details of such land. The candidate will not be given the opportunity                                                                                                                     Persons belonging to this category should produce a copy of certificate or Tamrapatra from the
                                                                                                               by Ministry of Social Justice & Empowerment will be applicable. Totally Deaf, Dumb or Blind
         to offer any other land subsequently. For this purpose, the land owned by member(s) of the                                                                                                                           Ministry of Home Affairs, Govt. of India or an attested copy of the pension order issued by the
                                                                                                               persons are also eligible.
         family unit shall also be considered as belonging to applicant subject to consent in writing of                                                                                                                      Accountant General in pursuance of the sanction letter from the Ministry of Home Affairs for the
                                                                                                               Please attach a copy of certificate from the Civil Surgeon/ Chief Medical Officer or Supdt. of
         the concerned member(s) of the family unit. The family unit in case of married applicant, for                                                                                                                        grant of Swatantrata Sainik Samman Pension under 'Freedom Fighter Pension Scheme' as
                                                                                                               Government Hospital in the format enclosed as Appendix B.
         this purpose, would comprise of i) Spouse ii) unmarried Son (s)/unmarried Daughter(s) and in                                                                                                                         proof of his / her being a freedom fighter.
         case of unmarried applicant would comprise of (i) his/her unmarried brother(s) /unmarried             Defence Personnel Category (DEF/DC):
                                                                                                               Persons belonging to this category should be sponsored by Director General of Resettlement               c.    Age:
         sister(s) and (ii) parents. The land on long term lease of a minimum of 15 years as on the date                                                                                                                      As on the date of Application (in completed years): Not less than 21 years. Enclose an
                                                                                                               (DGR), Ministry of Defence, Govt. of India, as per the following inter-se priority.
         of application, will be treated as “owned” land for this purpose.                                                                                                                                                    attested copy of either Matriculation or Secondary School Leaving Certificate indicating date
                                                                                                               (a) Widows/ dependants of posthumous gallantry award winners.
vii.     In case the land offered is on National Highway, the same should meet the NHAI guidelines             (b) War Widows / dependants of those who died in war.                                                          of birth, identity card issued by election commission or an affidavit as proof of age.
         contained in Govt. of India, Ministry of Road Transport & Highways No.RW/NH-33023/19/99-              (c) War disabled.                                                                                        d.    Educational Qualification :
         DO-III dt. 25.09.03/17.10.03 and further amendments if any, failing which the offered land will       (d) Widows / dependants of those who died in harness due to attributable causes                                Minimum Matriculation or recognised equivalent. Enclose an attested copy of either
         not be considered for evaluation as above and the candidate will be treated at par with those         (e) Disabled in peace due to attributable causes                                                               matriculation or equivalent and other qualification certificates as proof. The eligibility criterion
         candidates who have not offered land. The offered site should also meet norms of statutory            Please attach a copy of certificate from Directorate General of Resettlement (DGR), Ministry of
                                                                                                                                                                                                                              on educational qualification is not applicable in respect of applicants applying for dealerships
         bodies like forest, explosive etc. and land should be convertible for commercial and petrol           Defence, Govt. of India sponsoring the candidate for the dealership for which he/she has
                                                                                                                                                                                                                              reserved for FF, OSP, PMP & Defence categories. However persons applying for these
         pump use.                                                                                             applied.
                                                                                                                                                                                                                              categories would be assessed for educational qualification.
                                                                                                               Certificate of Eligibility issued for one particular location/dealership will not be valid for another
viii. The Dealer selection guidelines of HPCL including evaluation criteria can be accessed                                                                                                                             e.    Multiple Dealership Norm (relationship clause):
                                                                                                               location/dealership. The certificate can be submitted by (DD/MM/YYYY), in case presently
      by the applicants at our website www.hindustanpetroleum.com. The application format                                                                                                                                     For Individuals including Partnerships                                            (Contd. on page 3)
                                              HINDUSTAN PETROLEUM CORPORATION LIMITED
                                                                                                                                   (A Government of India Enterprise)

                                                                                    NOTICE FOR APPOINTMENT OF RETAIL OUTLET DEALERS
(Page 3, continued from Page 2)
     Persons desirous of applying should not be having either letter of Intent (LOI) or Dealership/                  should produce the proof of acceptance of his/her resignation by his/her employer.                                                                                                                 APPENDIX- A
      Distributorship of MS/HSD/SKO-LDO/LPG of any Oil Company in his/her own name or in the (b) On selection, the candidate will be required to deposit with the oil company a security deposit,
      name family members in his/her family unit.                                                                    ranging from Rs. 2 lakhs to Rs. 5 lakhs as mentioned in the advertisement as per the policy of                             (TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER
     Family unit, in case of married applicant, for this purpose, would comprise of i) Spouse                        HPCL. Such deposit will have to be made at the time of appointment as dealer. This amount                                                   OF REQUIRED VALUE)
      ii) unmarried Son (s)/ unmarried Daughter(s) and in case of unmarried applicant would                          called the security deposit is refundable at the time of resignation / termination and will not
      comprise of (i) his/her unmarried brother(s) /unmarried sister(s) and (ii) parents.                            carry any interest. HPCL also reserves its right to adjust any dues to it from this amount at the                                    AFFIDAVIT FOR INDIVIDUALS & PARTNERS
     For Non-Individual entities:                                                                                    time of resignation/ termination. However, in case such termination is due to proven
     For Companies registered under Companies Act 1956:                                                                                                                                                                         I, ________________________ son/daughter/wife of_________________ Age ___ years
                                                                                                                     adulteration/malpractices then the deposit amount will be forfeited. SC/ST allottees, war
i.   The applicant company will not be eligible for RO/SKO/LPG dealership/distributorship,                           widows and widows and women above 40 years of age without earning parents, availing                        residing at____________________________ do hereby solemnly affirm and say as under :
      if any RO/SKO/LPG dealership/ distributorship or Letter of Intent (LOI) is held by the                         facilities under corpus fund scheme will be exempted from payment of such security deposit.                 1. That I am an Indian National.
      applicant Company or by any of the following :                                                                                                                                                                             2.   That I am unmarried. That neither I nor my Father, Mother, unmarried brother(s),
                                                                                                                (c) Other things being equal, Unmarried women above 40 years of age without earning parents
     a. Any of the Director or his family members (family as defined in the case of multiple                                                                                                                                          unmarried sister(s) have dealerships/distributorships or hold Letter of Intent for Retail Outlet
                                                                                                                     and Widows will be given preference over others in all women categories. Widow has to
           dealership norms for individuals)                                                                                                                                                                                          or SKO-LDO dealership or LPG distributorship of any Oil Company
                                                                                                                     submit death certificate of her husband and also an affidavit stating that she has not re-married
     b. Holding company or Subsidiary company.
                                                                                                                     as per Appendix A.                                                                                                                                           OR
     c. Any other company or Firm where share holders (put together) of the applicant company
           have controlling stake i.e. 51% or more.                                                                   submit death certificate of her husband and also an affidavit stating that she has not re-married
                                                                                                                                                                                                                                 That I am married. That neither I nor my spouse, unmarried son(s) / unmarried daughter(s)
ii. If any individual, partnership firm, company, organized body, trust or society, already holding                  as per Appendix A.
                                                                                                                                                                                                                                 have dealerships / distributorships or hold Letter of Intent for Retail Outlet or SKO-LDO
      RO dealership, SKO/LPG distributorship acquire controlling stake in a company having RO 10. Provision for Basic Facilities at the Retail Outlet :
                                                                                                                                                                                                                                 dealership or LPG distributorship of any Oil Company.
      dealership, SKO/LPG distributorship, then the RO dealership, SKO/LPG distributorship of the (a ) The applicant on selection should be capable to raise necessary funds for effectively operating
      acquirer is liable to be terminated.                                                                                                                                                                                       3. @ That I am a unmarried woman above 40 years of age without earning parents
                                                                                                                     the dealership to the satisfaction of HPCL.
iii. Government owned Companies defined as major shareholding with the Government, Public (b) Following basic facilities will be provided by each dealer at the Retail Outlet.                                                   4. @ That I am a widow and not re-married.
      Sector & Joint Sector Units or Government administered Organizations will be exempted                                                                                                                                         [ @ DELETE THESE IF NOT APPLICABLE ]
                                                                                                                      Drinking Water, Free Air , First Aid kit with medicines (@), Toilet, Pollution under Control
      from the multiple dealership norms as per existing policy adopted by OMCs.                                     Equipment, viz., PUC (@), wherever it is mandatory, Telephone, Adequate illumination.                       5. I have never been convicted and / or no charges have been framed by a Court of law against
     For organized bodies, charitable trusts registered with the Charity Commissioner of the                          @ Facilities marked with @ will be provided by HPCL to those dealers who are entitled                         me for any criminal offence involving moral turpitude / economic offences (other than
      respective State Government and Societies registered under Societies Registration                              for financial assistance under 'Corpus Fund Scheme' and outlets developed under                                 freedom struggle).
      Act, 1860.                                                                                                     Co-Owned category.
     Such entities will not be eligible for RO/SKO/LPG dealership/distributorship if any (c) In addition, candidates selected for locations against which YES has been marked under                                              6. I hereby confirm that I was never a signatory to a dealership/distributorship agreement
      RO/SKO/LPG dealership/distributorship or Letter of Intent (LOI) is held by it or by any Member                                                                                                                                of any oil company, which was terminated for proven adulteration/malpractices.
                                                                                                                     col.(E) of the table, will be required to provide the following facilities also at the Retail Outlets as
      of the Governing Body/Managing Body/any such other Body or his family members (family as                       may be required by HPCL and as per layout & standards prescribed by HPCL at his/ her own                    7. That against item no.13 of my application form details of various sources of funds required
      defined in the case of multiple dealership norms for individuals).                                             cost :                                                                                                         for setting up and operation of the dealership has been furnished. I undertake that these
f) Residence Certificate:                                                                                       ü Mandatory Facilities : Land & its development, Driveway, Compound wall, Sales Office,                             funds will be made available for the purpose stated above. In case it is found that the same is
     In case of application for “Hamara Pumps” in rural markets, the applicant should be a resident                  Show Room, Store, Toilets, Generator & Compressor Room, Yard lighting, Air & Water                             not made available as and when required, the offer of dealership, at any stage, can be
      of the concerned district. To qualify for such candidature, a proof of residence certificate from              Facilities, Generator, Fire Fighting Facilities, etc.                                                          withdrawn and that I will have no claim/damages whatsoever against the oil company.
      the competent authority must be attached with the application.                                            ü Additional Facilities (Site specific) : All such facilities required for customer service such as               8. I hereby verify that what has been stated above is true to the best of my knowledge and
3. Disqualification                                                                                                  Staff Room cum Change Room, Canopy, Service Station, Rest Room, Restaurant, Telephone                           belief and nothing material has been concealed thereof. If any information/declaration given
     (a) Person who has been convicted or against whom charges have been framed by a Court of                        Facilities, PUC facility (if mandatory) and/other Facilities as may be specified by HPCL from
           Law for any criminal offence involving moral turpitude/economic offences (other than                                                                                                                                      by me in my /our application or in any document submitted by me/us in support of
                                                                                                                     time to time.
           Freedom Struggle), would not be eligible to apply.                                                                                                                                                                        application for the award of ______________dealership or in this affidavit shall be found to
                                                                                                                11. CORPUS FUND SCHEME FOR WAR WIDOWS & WIDOWS AND UNMARRIED WOMEN
     (b) Totally paralysed or mentally unsound persons (Who suffer from insanity) are not eligible                                                                                                                                   be untrue or incorrect or false, Hindustan Petroleum Corporation Ltd would be within its
                                                                                                                     ABOVE 40 YEARS OF AGE AND WITHOUT EARNING PARENTS
           to apply under any category.                                                                                                                                                                                              rights to withdraw the letter of intent / terminate the dealership (if already appointed)
     (c) Signatories of dealership/distributorship agreements which were terminated by any oil                        On their application and subject to satisfaction of HPCL, unmarried women above 40 years of
                                                                                                                                                                                                                                     and that we would have no claim, whatsoever, against Hindustan Petroleum Corporation
           company for proven malpractices / adulteration are not eligible to apply.                                 age without earning parents and widows, selected for dealership in all categories will be
                                                                                                                     entitled to a retail outlet developed by the Corporation and also the financial assistance under                Ltd for such withdrawal/termination.
     (d) Guilty of wilfully giving wrong information.
     The applicant will have to furnish an affidavit covering point nos. 2 (a), 2 (e), 3(a) and 3(c) in this         the corpus fund scheme. War widows will also be eligible for the Corpus Fund facilities, in case            Solemnly affirmed and declared before me
      regard as per Appendix A.                                                                                      dealership is allotted to them.
     Married Women applicant with change of name after marriage should submit a copy of the 12. Applications for locations Sr. No. 1 to 103 should be submitted at our Pune Office                                               This ___________day of ________________
      marriage certificate or an affidavit in support of the maiden name and name after marriage.                    address and Sr. No. 104 to 161 at our Goa office address on plain paper in the prescribed
4. Partnerships : In case of partnership, each partner should individually meet the specified                        format given in the advertisement, along with a non-refundable application fee of
     eligibility criteria and also should submit separate application forms along with separate                      Rs.1000/- (Rupees One Thousand Only), by a Crossed Account Payee Demand
                                                                                                                                                                                                                                      _______________________                                _______________________
     application fee. However, the applications should be clubbed together. If called for interview,                 Draft/Pay order (Rs. 500/- in case of SC/ST candidates along with proper documentary
                                                                                                                                                                                                                                      Signature and Seal of                                   Signature of person making affidavit
     all of them must appear for interview. They also have to submit a copy of the proposed                          evidence of caste/ tribe) for regular ROs and Rs.100/- (Rs.50/- in respect of SC/ST
                                                                                                                                                                                                                                  Magistrate/Judge/Notary public                                    (Name in block letters)
     partnership deed.                                                                                               candidates) in case of Hamara Pumps (in Rural areas) drawn on any Scheduled Bank in
5. Registered Co-operative Societies/ Consumer Co-operative Societies are eligible to apply                          favour of Hindustan Petroleum Corporation Ltd., payable at, Pune/Goa Respectively.
     under any category provided all the members of the society belong to the category for which                                                                                                                                                                                                                      APPENDIX - A1
                                                                                                                      PUNE OFFICE                                        GOA OFFICE
     the location has been advertised for and also provided that the individual members should                                                                                                                                           (To be submitted by Registered Co-operative Societies, Organised bodies,
     meet the non conviction clause including the society as an entity. Moreover, the society should                  Sr. Regional Manager,                              Chief Regional Manager,                                                 Fleet Operators, Charitable Trusts and Corporate Houses)
     be making net profit for the last 3 financial years. For any society applying for location reserved             Pune Retail Region,                                 Vasco Retail Region,
     for women category, all the members should be women. The members individually and the                           Hindustan Petroleum Corporation Ltd., Hindustan Petroleum Corporation Ltd.,
                                                                                                                                                                                                                                            (TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF
     society as an entity also should not have been a signatory to dealership/distributorship                        3/C, Dr. Ambedkar Road,                             C/o. Vasco Terminal,
                                                                                                                     Near Nehru Memorial Hall Camp,                      F. L. Gomes Road, P. B. No. 48,                                                                REQUIRED VALUE)
     terminated by any oil company for proven adulteration/malpractice. The Society has to furnish
     appropriate resolution to show that the person making the application is empowered to make                      Pune - 411 001.                                     Vasco-Da-Gama - 403 802
     the same. Parameters relating to educational qualification and personality would not be                                                                                                                                                                                  AFFIDAVIT
     applicable to such societies                                                                                     GENERAL TERMS AND CONDITIONS :
6. Organised bodies : Organised Bodies such as registered bus/truck associations etc.,                          (a) While any individual meeting the eligibility criteria as mentioned above can apply under Open               In the matter of_____________ dealership of, Hindustan Petroleum Corporation Ltd,
     Charitable Trust and corporate houses i.e. Government Organisations/Bodies, PSUs, Public                        Category, for any location reserved for a particular category the individual meeting all the               at_______________(Location) Whereas _______________(Name of the Co-operative
                                                                                                                     eligibility criteria specified for that category only can apply.                                           Society*/organised body*) ____________       (Location) has applied for RO dealership of ,
     Limited Companies incorporated under Companies Act, 1956 are eligible to apply under
                                                                                                                                                                                                                                Hindustan Petroleum Corporation Ltd at ___________.
     OPEN category. Parameters relating to educational qualification and personality will not be (b) Filled application along with relevant enclosures complete in all respects to be submitted so as
     applicable in their cases. Pvt Ltd Companies are not eligible to apply.                                         to reach the office address mentioned above on or before 4 p.m. (1600 hrs) on 18.09.2009.                  I,_____________________________ son/daughter/wife of ___________ Age _____ years
                                                                                                                       All the pages of application along with enclosures should be serial numbered and total                   resident of _________in the capacity of ___________do hereby solemnly declare :
7. Scrutiny of application form: The valid application received up to the time/ date specified in
                                                                                                                     number of pages to be indicated on top of the application.
     the advertisement will be scrutinised by a team of officers and the candidate found eligible as
                                                                                                                                                                                                                                 1. That through a resolution passed by the Co-operative society*/organised body* I have been
     per the eligibility criteria and other terms and conditions will be called for a personal interview. (c) The company reserves the right to cancel/withdraw/ amend this advertisement or extend the
                                                                                                                     due date at its sole discretion without assigning any reason.                                                   authorised to apply for the said dealership. A copy of the resolution/authorisation is
     The document submitted by the applicant along with the application form will be scrutinised                                                                                                                                     enclosed herewith forming part and parcel of this affidavit.
     and the land details/ document will be evaluated by a team, including the site visit as may be (d) No addition /deletion/ alteration will be permitted in the application once it is submitted.                             2. That the said Co-operative Society*/organised body* is duly registered and a photocopy of
     necessary to establish the suitability of the offered land, if any, for setting up of a retail outlet. (e) No additional documents whatsoever will be accepted or considered after the cut off date of the                      the registration certificate is enclosed herewith forming part and parcel of this affidavit.
     Ineligible applicants will not be called for the interview and will be advised in writing along with            application.                                                                                                3. That the said Co-operative Society*/ organised body* is a profit making body during last 3
     reason for the rejection of their application.                                                             (f) Applications received after the cut-off date including postal delay, and those without                           consecutive Financial years. (Delete if not applicable). A copy of certificate from chartered
8. Evaluation of candidates                                                                                          accompanying valid documents including application fee or incomplete in any respect will not                    accountant is enclosed herewith forming part and parcel of this affidavit.
     For Individual candidates including partnerships:                                                               be considered and no correspondence will be entertained by HPCL in such cases whatsoever.                   4. That on behalf of the Co-operative Society*/organised body*, I undertake that I will observe
     Each candidate will be assessed under the following parameters:                                            (g) All affidavits have to be submitted in original along with the application.                                      all the relevant guidelines with regard to award/operation of the said dealership issued by
     a) Capability to provide land and infrastructure/ facilities*               35 marks                             ü Individual applicants & partnerships (individually)….. As per Appendix A                                     the, Hindustan Petroleum Corporation Ltd /Government of India or any other statutory body
     b) Capability to provide finance*                                           25 marks                             ü Co-op societies/organized bodies………as per Appendix A1                                                        from time to time.
     c) Educational qualification                                                15 marks                             ü Banker's certificate as per Appendix A2 (except by candidates applying for locations                     5. That all members of the Co-operative Society* belong to the reserved category for which the
     d) Capability to generate business                                          10 marks                                   reserved for SC/ST)                                                                                      location has been advertised including for women and none of the members have been
     e) Age                                                                       4 marks                             ü Affidavit with regard to tapping of sales potential from prospective customers as per                        convicted and / or no charges have been framed by a Court of law against them for criminal
     f)     Experience                                                            4 marks                                   Appendix A3                                                                                              offences involving moral turpitude and / or economic offences (other than freedom
     g) Business ability /acumen                                                  5 marks                             ü PH category persons have to submit certificate as per Appendix B.                                            struggle). Moreover, none of the member was ever signatory to a dealership/
     h) Personality                                                               2 marks                             ü Residency certificate of candidates applying for “Hamara Pumps” in rural markets                             distributorship of any oil company, which was terminated for proven adulteration
                                                                                                                      ü Death certificate in case of war widows/ widows                                                              /malpractices. A copy of the certificate to this effect from the Registrar of Co-operative
            Total                                                              100 marks                                                                                                                                             Societies is enclosed herewith forming part and parcel of this affidavit. (applicable for co-
                                                                                                                (h) In respect of all documents /certificates, only attested copies are to be attached along with                    operative societies/consumer societies only).
     * In respect of Land/Finance parameters as indicated in Dealer selection guidelines the                         the application. Originals of such documents / certificates will have to be brought at the time
     ownership of Land/Finance by the members(s) of the family unit is also considered as                                                                                                                                        6. That the Co-operative Society*/organised body* does not have any criminal records nor
                                                                                                                     of interview, if called for.                                                                                    does it have any criminal charges framed against it by court of law involving moral turpitude
     owned/belonging to the applicant subject to consent in writing of the concerned member(s) of
                                                                                                                (i) Applicants willing to apply for more than one location can do so in separate application                         and/or economic offences.
     the family unit. The family unit in case of married applicant, for this purpose, would comprise
                                                                                                                      formand also enclosing separate Demand Draft/Pay Order as application fee. Each                            7. That the Co-operative Society*/organised body* was never a signatory to a dealership/
     of i) Spouse ii) unmarried Son (s)/ unmarried Daughter(s) and in case of unmarried applicant
                                                                                                                      application should be complete in all respects.                                                                distributorship agreement of any oil company, which was terminated for proven adulteration
     would comprise of (i) his/her unmarried brother(s) /unmarried sister(s) and (ii) parents
                                                                                                                (j) If any statement made in the application or in the document enclosed therewith or                                / malpractices.
     Minimum qualifying marks:                                                                                                                                                                                                   8. That the applicant company hereby confirms that the applicant company or any of the
                                                                                                                      subsequently submitted in pursuance of the application by the candidate at any stage is found
     Open category :                                      60 % of the total applicable marks                                                                                                                                         following do not hold RO/SKO/LPG dealership/distributorship or Letter of Intent (LOI) :
                                                                                                                      to be incorrect or false, the application is liable to be rejected without assigning any reason and
     Reserved category including Open (W) : 50 % of the total applicable marks
                                                                                                                      in case the applicant has been appointed as a dealer, the dealership is liable to be terminated.           a. Any of the Director or his family members (family as defined in the case of multiple
i.   Scheduled caste/Scheduled tribe candidates for locations reserved for them and war widows                        In such cases the candidate / dealer shall have no claim whatsoever against HPCL.                             dealership norms for individuals)
     applying for dealerships will not be judged under the heads “Capability to provide infrastructure                                                                                                                           b. Holding company or Subsidiary company.
                                                                                                                (k) The envelope containing the application, duly filled in, should be superscribed as under :
     and facilities” and “Capability to provide Finance”.                                                                                                                                                                        c. Any other company or Firm where share holders (put together) of the applicant company
                                                                                                                      ''This application is for a dealership of a new retail outlet at_____________ (location)''.
ii. Subject to their application and request, widows and unmarried women above 40 years of                                                                                                                                           have controlling stake i.e. 51% or more.
                                                                                                                (l) All applicants should submit a fresh affidavit in Appendix A or Appendix A1 as the case may be,
     age, without earning parents, for locations reserved for women will not be judged under the                                                                                                                                                                                   OR
                                                                                                                      at the time of interview.
     heads “Capability to provide infrastructure and facilities” and “capability to provide Finance”.                                                                                                                                Organized bodies, charitable trusts registered with the Charity Commissioner of the
                                                                                                                (m) Applications not submitted strictly in accordance with the terms and conditions of this
     These applicants will be required to indicate in the application form itself whether they would                                                                                                                                 respective State Government and Societies registered under Societies Registration Act,
                                                                                                                      advertisement will be liable to be rejected witout assigning any reason.                                       1860, hereby confirm that no RO/SKO/LPG dealership/distributorship or Letter of
     like to avail the facilities. In case, this is not indicated in the application form, it will be construed
     that these applicants would like to get evaluated in line with other applicants i.e they should            (n) The applicant would carefully go through the brochure available on our web site and available                     Intent(LOI) is held by it or by any Member of the Governing Body/Managing Body/any such
     also be assessed under the Heads - “Capability to provide infrastructure and facilities” and                     at a cost of Rs.50/- at the address of our Regional Office as given under clause no. 12                        other Body or his family members (family as defined in the case of multiple dealership norms
                                                                                                                      before submitting their applications.                                                                           for individuals).
     “capability to provide Finance”. For determining the priority to be given to such candidates
                                                                                                                                                                                                                                 9. @ That against item no.13 of my application form details of various sources of funds
     over other women candidates, the marks secured by other women under these two (o) A person selected for dealership after issuance of letter of appointment will have to execute a
                                                                                                                      dealership agreement with HPCL as per the terms of HPCL.                                                       required for setting up and operation of the dealership has been furnished. I undertake that
     parameters will be excluded by the total marks secured by them.                                                                                                                                                                 these funds will be made available for the purpose stated above. In case it is found that the
iii. Candidates, other than those mentioned under i & ii above and applying for locations ear (p) This is purely a business proposition and not an application for job in HPCL and has normal                                        same is not made available as and when required, the offer of dealership, at any stage, can
     marked under 1(ix) shall not be judged under the heads of capability to provide land and                         business risks and also do not guarantee any assured returns or profits.                                       be withdrawn and that I will have no claim/damages whatsoever against the, Hindustan
     infrastructure/ facilities.                                                                                (q) This is only an application and not an offer of dealership.                                                      Petroleum Corporation Ltd.
     For Non-Individual Applicants (viz., for Companies Registered under Companies Act (r) Complaints against dealer selection received after one month from the date of publication of                                          10. I hereby verify that what has been stated above is true to the best of my knowledge and
                                                                                                                      the result of interview will not be entertained. Efforts will be made to ensure that the complaints            belief and nothing material has been concealed therefrom. If any information/declaration
     1956, for Organized Bodies, Charitable Trusts registered with the Charity
                                                                                                                                                                                                                                     given by me in my application or in any document submitted by me in support of my
     Commissioner of the respective State Govt and Socities Registered under Societies                                are disposed off within 3 months from the date of receipt of response of the complainant. The
                                                                                                                                                                                                                                     application for the award of the dealership or in this affidavit shall be found to be untrue or
     Registration Act 1960)                                                                                           disposal of complaints will be done by way of speaking order                                                   incorrect or false, Hindustan Petroleum Corporation Ltd would be within its rights to
                                                                                                                      by the appropriate authority. The complainant will be advised in writing about disposal of the                 withdraw the letter of intent / terminate the dealership (if already appointed) and that I would
     a) Capability to provide land and infrastructure/ facilities               35 marks
                                                                                                                      complaint.                                                                                                     have no claim, whatsoever, against , Hindustan Petroleum Corporation Ltd. for such
     b) Capability to provide finance                                           25 marks
     c) Educational qualification                                                0 marks                        (s) Pending disposal of complaints, LOI will be kept in abeyance.                                                    withdrawal/termination.
     d) Capability to generate business                                         25 marks                        (t) Disposal of complaints will be as per the established complaint redressal system as specified                *strike out whatever is not applicable.
     e) Age                                                                      4 marks *                            in the dealer selection guidelines                                                                         Solemnly affirmed and declared before me
     f)     Experience                                                           4 marks **
     g) Business ability /acumen                                                 7 marks                                                                                                                   APPENDIX- A3          This ___________day of ____________________________
     h) Personality                                                              0 marks
            Total                                                             100 marks                            (to be obtained from the prospective customers and to be submitted by the applicant
                                                                                                                                                         along with the application)
     *Evaluation of Age for Non-Individual candidates will be done as follows :
     No of years of existence                                               Marks to be awarded                             (TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)
                                                                                                                                                                                                                                      ____________________________                            ____________________________
     1. Less than 3 years of existence                                             0 marks                                                                        AFFIDAVIT                                                                 Signature and Seal of                             Signature of person making affidavit
     2. Equal to or More than 3 years but less than 5 years                        2 marks                       I,________________________________________________________son / daughter / wife of                                     Magistrate/Judge/Notary public                       (Name & Designation in block letters)
     3. Equal to or more than 5 years                                              4 marks                       __________________________________________________ Age _____ years residing at
      **Evaluation of Non-Individual candidates under Experience will be as follows :                           ______________________ do hereby solemnly affirm and say as under :                                                                                                                                    APPENDIX- A2
w     Sector                                                 Marks to be awarded                                1. ________________________________________ (Name of applicant), son / daughter of                                       (to be submitted by all applicants except those applying under category reserved
      1. Petroleum Sector                                         4 marks                                             _________________,resident of ______________________________________                                                                    for SC/ST and War Widows applicants)
      2. Automobile/Transport service                             2 marks
      3. Any sector other than mentioned above                     1 mark                                             (address) has applied for Retail Outlet dealership at_______________ (location) of
                                                                                                                                                                                                                                                                 To whomsoever it may concern
      Note: At least one year of experience of providing services in a particular sector will                         __________________(name of Oil Co.).
      entitle the candidate for full marks. No marks will be awarded for service/experience of                  2.    I am having approx. consumption of ________ KL per month of ________ (name of product)                    Shri /Ms /M/s. _________________________________ is a customer of this bank / institution for
      less than 1 year                                                                                                required for _________ (purpose).                                                                         last _____ years and he / she / they, is/are enjoying the following facilities of our bank / institution:
iv.   Locations reserved under DEF and PMP category:- In respect of the candidates securing                     3.    I hereby confirm that in case the dealership is awarded to above applicant, I will be taking my           a.
      minimum qualifying marks, the inter-se-priority marks given by the competent authority                                                                                                                                    b.
                                                                                                                      supplies through him to the extent of ____ KL per month subject to the commercial terms and
      (max. 40) will be added to the above and accordingly the final merit position decided.                                                                                                                                    c.
                                                                                                                      conditions agreed mutually
v.    The marks awarded to the candidates placed in the merit panel, displayed on the notice-
                                                                                                                4.    I hereby confirm that this type of commitment has not been given to any other candidate                   During the above period, the dealing of Shri / Ms/ M/s________________________ with the
      board by the selection committee after their interview shall be subject to scrutiny, subsequently
                                                                                                                      applied for the above location.                                                                           bank and he /her / their conduct has been satisfactory. In case, a dealership is allotted to him / her /
      by a Senior officer of the Corporation on whose satisfactory report, the Head Zone shall ratify
                                                                                                                5.    I hereby verify that what has been stated above is true to the best of my knowledge and belief            them, we will be willing to extend a loan of Rs. __________ (Rupees______________(in words).
      the displayed Merit Panel, which then only shall be considered to be final
9.    Other terms and conditions:                                                                                   and nothing material has been concealed there from.                                                         Signature
(a) The candidate selected for dealership shall be a working dealer and shall be paying attention               Solemnly affirmed and declared before me
                                                                                                                                                                                                                                Name and Designation :
    towards day to day working of the dealership by personally managing the affairs of the                      This ___________day of ________________
    dealership. He/she will not be eligible for taking up any other employment. If the selected                         _______________________                                _______________________                          Office Seal :
    person is already employed, before issuance of Letter of Appointment by the oil company                              Signature and Seal of                                 Signature of person making affidavit             Date :
                                                                                                                     Magistrate/Judge/Notary public                                  (Name in block letters)                                                                                                           (Contd. on page 4)
                                         HINDUSTAN PETROLEUM CORPORATION LIMITED
                                                                                                                        (A Government of India Enterprise)

                                                                             NOTICE FOR APPOINTMENT OF RETAIL OUTLET DEALERS
(Page 4, continued from Page 3)
                          APPLICATION FOR HPCL RETAIL OUTLET                                                                                                                                                application. However, originals of all these will have to be brought at the time of interview,
                          (PETROL PUMP)/SKO-LDO DEALERSHIP                        Passport Size     6.    Do you have business / selling experience? if yes, give full details ____________________
                                                                                    Photograph            ________________________________________________________(attach addl sheets)                      if called for.
                      (Please go through the “Brochure” available on our
                                                                                  with specimen     7.    Do you have experience of supervision of personnel? if Yes, give full details.                    17. Any other information:
                       website or at our Regional Offices carefully before       signature on the
                                                                                                          __________________________________________________ (attach addl sheets)                           18. UNDERTAKING : I undertake to produce Originals of all the attachments enclosed with this
                                filling in this application format)                 Photograph
                                                                                                    8.    Please attach a separate sheet giving your detailed plans to run the dealership.                  application at the time of interview, if called and is aware that in the event I fail to produce the
                                                                                                                                                                                                            Originals, my application for dealership will be disqualified. I am fully aware that M/s
Location(at or around) _______________Rev. Distt.________________ State___________                  9.    In case of partnership, please give name of each of the partners and attach Proposed
                                                                                                                                                                                                            HindustanPetroleum Corporation Ltd. under its policy will not appoint me as their dealer if I am
Category _________ (OP/ OP-W/ SC/SC-W/ ST/ ST-W/ PH/ PH-W/ PMP/ PMP-W/ DC/DC-W/                           Partnership Deed. Application of all the partner(s) should be attached together while
                                                                                                                                                                                                            employed. I shall have to resign from the service and produce proof of acceptance of my
FF/ FF-W/ OSP/ OSP-W): (Please attach copy of certificates as proof from the respective                   submiting : _____________________________________________________________                         resignation by my
competent authorities).                                                                             10.   Were you a signatory to a retail outlet / SKO-LDO dealership / LPG distributorship of any Oil     employer to HPCL before issuance of Letter of Appointment for the dealership.
Advertised on _____________ in ________________ by HINDUSTAN PETROLEUM                                    company terminated for proven adulteration / malpractice? If yes, give details. Otherwise         That, If selected, I undertake that I will be required to deposit an interest free Security deposit as
                      (Date)       (Name of Newspaper)         CORPORATION LTD.                           submit an affidavit as per Appendix 'A'.                                                          per the policy of HPCL.
Status : Individual/ Partnership/Regd. Co-operative Society/Organised body/Corporate                11.   Registered Co-op. Society/ Organised body: (Organised bodies can apply under                      I, _________________________________________________________________________
House/Fleet Operator/Charitable Trust                                                                     'OPEN' category only)                                                                             hereby certify that the information given above is true to the best of my knowledge and belief. Any
(Tick as applicable)                                                                                      (a) Name of the Society/organized body:_______________________________________                    wrong information / suppression of facts will disqualify me from being considered for the
1. Individual : ( Individuals to enclose Affidavit as per Appendix 'A')                                   (b) Address : ______________________________________________ PIN:__________                       dealership.
    (a) Name (in Block Letters) : Mr / Ms. __________________________________________                         Telephone No.:_________________ E-Mail Address:__________________
    (b) Father's/ Husband's Name: ______________________________________________                              (Enclose affidavit as per Appendix 'A1')
    (c) Address: ____________________________________________________________                                                                                                                               Place    :                                                                         Signature
                                                                                                              Copies of audited Profit & Loss account statement for the previous 3 financial years to be
          __________________________________________PIN:______________________                                enclosed                                                                                      Date     :                                                                 (Name in block letters)
          Telephone No. :________________E-Mail Address: __________________________                 12.   Land details (to be provided by all applicants):                                                  Encl     :   Total of _____ no. of documents with this application,
    (d) Nationality: ___________________
                                                                                                          (a) Do you have a suitable site readily available at or around the location where the
    (e) Date of Birth : ____________Completed Age as on date of application:____________                                                                                                                    Encl     :   Checklist for supporting documents/affidavits
                                                                                                              dealership has been advertised ?                                    Yes / No
          ( Proof to be attached)
                                                                                                              If yes City/Town/Village_____________District_____________State:_____________
    (f) Educational Qualification (s) : _____________________( Proof to be attached)
                                                                                                              Survey No : ______Hissa No./Patwari Halka No. : ________Name of the Road: _____
    (g) Resident of : _______________Town:_______________District_____________State
          (Residence Proof to be attached in case of “Hamara Pumps” in Rural Market)                          NH No. / SH No. / Other Road :_______________Nearest Km Stones : _____________                                           CERTIFICATE OF MEDICAL OFFICER FOR                           APPENDIX 'B'
    (h) Gender :___________________ (Male / Female)                                                           Total land area : (Acre/Sq.m) _________ (Site map with dimensions to be attached)                                       PHYSICALLY HANDICAPPED CANDIDATES
    (i) Marital Status:_________________(Unmarried/Married/Widow/Widower/Divorcee)                        (b) Name of the owner of the land :_______________________(proof to be attached)
                                                                                                                                                                                                            Certified that I, Dr_______________________ Registration No_____________ have, this
    (j) In case of married applicant please give:                                                         (c) Relationship of land owner with the applicant :_______________________                        _______ day of______________ examined the candidate, whose particulars are given below:
          Full Name of Spouse: ___________________________                                                (d) Are you willing to transfer the land on sale/long lease to the Oil Co.?        Yes / No
                                                                                                                                                                                                            1. Name:___________________________________________________
          Full Name of unmarried Children:                                                                    If yes, at what rate/ terms._____________________________________________
          1.___________________________________________________                                               (In case the applicant is not the land owner, consent letter/ Legal documents from            2. Identification Marks:__________________________________________________
          2.___________________________________________________                                               the Land owner to be enclosed)                                                                3. Sex :___________
          3.___________________________________________________                                     13.   Give details of source of funds: (to be provided by all applicants)                               4. Father's / Husband's Name:__________________________________________________
    (k) In case of unmarried applicant please give:                                                       The details to cover free & unencumbered Bank accounts/ Govt. Securities/ fixed deposits,         5. Approximate Age:___________
          1. Full name of Father: _________________________________                                       bankers/financial institution certificate for credit worthiness (in the enclosed Appendix A2) ,
                                                                                                                                                                                                            6. (A) Orthopaedically Handicapped
          2. Full name of Mother: _________________________________                                       loans, UTI, NSC, Bonds, Shares of public limited companies etc., details of other assets like
          3. Full name(s) of unmarried brother(s) /unmarried sister(s) _____________                      immovable property (land, building etc.). Movable properties like vehicle etc., any other            i) Nature of disability (tick the relevant from the following) : Post Polio Paralysis,
          _______________________________________________                                                 sources of income like from interest, rent, business etc. (please attach proof in all cases).              Hemiplegia, Quadriplegia, Congenital, Hemipelvectomy, Cheopats Wrist.
ü In case of unmarried woman above 40 years of age :                                                      The details under “Finance” may be provided in the following format : (Attach Separate               ii) Extent of disability
    q     Are your parents (Mother/ Father) earning?                        YES / NO                      sheet as required)                                                                                   iii) Estimate percentages
    q     Do you wish to avail the Corpus Fund facilities                   YES / NO
                                                                                                     Type       Details of a/c No. Etc.     Name of the holder        Relationship      Amount (Rs.)           iv) Use of appliance (if any)
ü In case of widows,
    q     Please advise the date of expiry of your husband (DD/MM/YY)                                                                                                                                          v) Any operation done or indicated
    q     Do you wish to avail the Corpus Fund facilities                   YES / NO                NOTE : Candidates applying under Category reserved for SC/ ST and War widows need not                      (B) Handicapped by way of “being blind”
    Please attach death certificate of your husband & also affidavit that you are not remarried.    provide details under para 12 & 13. Widows and Unmarried women above 40 years of age without               (C) Handicapped by way of “being dumb”
ü Married Women applicant with change of name after marriage should submit a copy of the            earning parents applying against locations reserved for Women Category and proposing to avail              (D) Handicapped by way of “being deaf”
    marriage certificate or an affidavit in support of the maiden name and name after marriage.     Corpus Fund Scheme Facilities also need not provide details under 12 and 13 above.
ü In case of War widows, please attach supporting documents issued by competent authority.          14. Wherever applicants state that they would be having tie up on sales volume with prospective         7. Any other particulars to clarify : The nature and extent of disability that the surgeon
2. Are you or any of your following close relatives is dealer or LOI holder of any MS-HSD/ SKO-         customers they would be required to submit an affidavit along with application, from such              might like to point out :
    LDO dealership or LPG distributorship of any oil company?                                           prospective customers in the prescribed format as per Appendix A 3.                                 Place : _______________________
    In case of married applicant:                                                                   15. Have you ever been convicted by a court of law for any criminal offence involving moral
     (i) Spouse (ii) Unmarried sons/unmarried daughters:                   YES / NO                     turpitude and / or economic offence (other than freedom struggle)? (Applicable to individuals,
    In case of unmarried applicant                                                                                                                                                                          Signature of Orthopaedic Surgeon
                                                                                                        partners, members of Co-op. society, Co-op. society as an entity and also organized body as
    (i) Parent (ii) unmarried brothers/unmarried sisters:                  YES / NO                                                                                                                         / Eye Surgeon / ENT Surgeon                                             ___________________
                                                                                                        an entity) Please state YES or NO________________________
    If yes, please furnish details: ________________________________________________                16. Demand Draft/ Pay order No. ________dated.________for Rs. ______drawn on                                                                                                           Designation
3. Gross Income during last financial year ended (state year)_____________Gross Income in               ______________(state Bank's name) in favour of Hindustan Petroleum Corporation Limited              Date : __________________                                                        (Seal)
    Rs _____ Attach Certificate                                                                         payable at _______________ is enclosed.
4. Present occupation: _____________________________________________________                                                                                                                                Counter signed by Civil Surgeon /
                                                                                                    NOTE : Affidavits are be enclosed in original. In respect of all other certificates /
5. In case you are an income Tax Assesse, please furnish PAN No:___________________                                                                                                                         Chief Medical Officer / Supt. Govt. Hospital
                                                                                                    documents, duly attested Photo copy/ True copy ONLY need be attached along with the

								
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