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:
