Format For Affidavit printable pdf download

Format For Affidavit

Annexure D

FORMAT FOR AFFIDAVIT

To,

M/s ( Name of OMC)

Dear Sirs,

I Mr. / Mrs.

…………… son/daughter/wife of Mr ……………. aged …. years,

residing at ……………………………………………………….. hereby solemnly affirm as

under:

That my ____________________(relation with the connection holder)

was in

possession of LPG connection from M/s _____________________________(name of

distributor of OMC) vide SV no._____________dated_____________Consumer No.

_______________.

That Shri/ Smt____________________________________ has passed away on

__________________. Attested copy of the death certificate is enclosed.

That I being the ___________________(relation of the next of kin) request that the LPG

connection may be transferred in my name.

I confirm that I am agreeable to submit the documents required for the same and to pay

the deposit for the equipment as per your terms.

I hereby undertake to indemnify M/s IOC/BPC/HPC against any claim by any other

person at a later date with regard to the transfer of the said LPG connection in my name.

SIGNATURE

NAME

Date:

Place:

Format For Affidavit