Annexures b Indane Gas Connection

Indane Gas Connection

1. Annexure B
FORMAT FOR AFFIDAVI T

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 Mr/Mrs. …………………………………. who was residing at
………………………………………………………… …………… has left with me your
equipment covered under your Subscription Voucher No……………………. dt. …………

Since Mr./Mrs ………………………………………. does not intend making us of the said
equipment, I request that the same may be transferred to my name and a fresh
consumer number be given.

S.V. No. …………………… dt …………………. Issued to Mr.
…………………………………………. is herewith surrendered.

I confirm that I am agreeable to submit the documents required for the same and giving
you deposit for the equipment as per your terms.

I hereby attach a letter from Mr./Mrs ……………………………………… requesting M/s
IOC/BPC/HPC to transfer the connection in my name and also authorizing you to hand
over the deposit amount to me.

I hereby undertake to indemnify M/s IOC/BPC/HPC against any claim that Mr./Mrs
……………………………………… may at a later date make on you in respect of either
equipment or the security deposit covered under your aforesaid S.V. for which deposit
has been refunded to me by you.

Thanking you,

Yours faithfully,


SIGNATURE
NAME
Date:
Place: