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Click ‘Get Form’ to open the lootah gas disconnection form in the editor.
Begin by filling out the CUSTOMER DETAILS section. Enter your Name, Gas Account Number, Bldg/Block/Frond, Apt/Villa Number, Email Address, Mobile Number, Date Requested, Time Requested, and Reason For Disconnection.
In the CUSTOMER UNDERTAKING section, write your name in the designated space and review the terms regarding outstanding amounts and security deposits. Ensure you understand your responsibilities before signing.
The ACCOUNT INFORMATION section will be filled out by the LBCG/QEN Call Center. You can leave this blank as it is not for customer input.
For the UTILITY INSPECTION section, ensure that all relevant meter readings and conditions of equipment are noted accurately. This will be completed by a technician.
Finally, review all sections for accuracy before submitting. Make sure to sign where indicated and provide any necessary acknowledgments.

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