Annexure C
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 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. I am unable to get a letter from Mr./Mrs ………………………………………. as he/she is ……………………………………
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 to pay the deposit for the equipment as per your terms.
I hereby undertake to indemnify M/s IOC/BPC/HPC against any claim that Mr. ……………………………………… may at a later date make on you in respect of either equipment or the security deposit covered under your aforesaid S.V. which deposit may be refunded to me by you.
Thanking you,
Yours faithfully,
SIGNATURE
NAME
Date:
Place: