AFFIDAVIT
I, _____
son/daughter of _____, Resident of _____, _____ do hereby solemnly affirm and
declare as under:-
1- That the deponent is the resident of the above said address.
2- That the deponent wants to take the New Gas connection of
_____ from the franchisee/distributors _____, at _____, _____.
3- That no Gas Connection has ever been allotted in the name of
the deponent.
4- That the deponent undertakes that the deponent abides by the
all rule and regulations/ terms and conditions of the _____.
Deponent
VERIFICATION
Verified that the contents
of my above affidavit are true to best of my knowledge and belief and nothing
concealed therein.
Verified at _____ on _________
Deponent