To

PQR,

STU,

Date : ……………………………………

Subject : Application for the replacement of faulty Refrigerator on behalf of Mr.XYZ.

Sir,

I ABC son of XYZ , resident of 232 PARA X want to replace our Refrigerator on behalf of my father , as he
is on duty and will not be able to replace by himself.

XYZ is a consumer of PQR with consumer number 4770 since 27-September-2050 .

LPG regulator no. …………………………. Is not working properly because of that it leaks gas which can be
very dangerous . So, kindly replace this faulty gas regulator with a new one , For this I have attached all
required documents along with this application. Kindly process our request, We will be very thankful .

Yours Truly

Mr. ABC

On behalf of Mr. XYZ

PQR

Customer signature …………………………………

Applicant Signature…………………………………..