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    AFFITIVITY NEW CUSTOMER

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    gajpati.gajpati
    AFFITIVITY NEW CUSTOMER

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    AFFITIVITY NEW CUSTOMER

    Uploaded by

    gajpati.gajpati
    3 views1 page
    AFFITIVITY NEW CUSTOMER

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    AFFITIVITY NEW CUSTOMER

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    3 views1 page

    AFFITIVITY NEW CUSTOMER

    Uploaded by

    gajpati.gajpati
    AFFITIVITY NEW CUSTOMER

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    BEFORE THE NOTARY PUBLIC; PARALAKHEMUNDI, DIST.GAJAPATI, ODISHA.

    AFFIDAVIT
    I Sri Soraj Ku Parichha S/o Late Dandasi Parichha age about 32 years resident of Deviti, Po- B sitapur , Parlakhemundi , Dist-Gajapati ,
    Odissa desire to take domestic LPG Connection in my Name and affirm as under:-
    1. That I am an Indian citizen
    2. That my date of birth is 18/07/1979
    3. That neither I , nor any other member of the household (household means a family consisting of husband ,wife unmarried children and
    dependent parents living together in a dwelling unit having common kitchen) possess any LPG connection from PSU Oil companies or Piped
    Natural Gas connection, for domestic use .
    4. That do not have Ration card in my name or in the name of any member of my family as defined above
    That I am enclosing the following documents
    a. Electrical bill as a proof residence
    b. Vote identity card /Driving Licence as proof of identity
    6. I confirm that the LPG connection issued to me will be used in my above mentioned address and for domestic cooking purpose
    only and I shall abide by all terms governing its use.
    7. That I shall not position any other LP Gas installations in the same kitchen.
    8. That as and when second cylinder is issued to me against this connection the same will also be used in the same kitchen and with
    the original installation
    9. That whenever I change my residence from present address to another, I will inform the M/s Gajapati enterprises ,
    Parlakhemundi, Dist-Gajapati (In writing in advance for change of address in the records.)
    10. That I am aware the domestic subsidized LPG on the basis of this affidavit and information submitted by me in the Know Your
    Customer (KYC) from proof of address and proof of Identity , shall later be subjected to de duplication check for existence of any
    other domestic subsidized LPG connection with any Govt. oil company in my name of any other member of my house hold as at
    para three above
    11. That if any information/declaration given by me in this undertaking or any document submitted in support of identity/ residence
    proof shall be found untrue or incorrect or false, Indian Oil Corporation/Bharat Petroleum Corporation/ Hindustan Petroleum
    corporation would be within its rights to withdraw the supply of Gas/Terminate the connection /Seize the equipments /forfeit the
    security deposit and that I would have no claim, whatsoever against Indian Oil Corporation /Bharat Petroleum
    Corporation/Hindustan Petroleum Corporation for such withdrawal/Termination/Siezure/forfeiture.
    hereby declare that whatever has been stated above is true to the best of my knowledge, correct and nothing material has been concealed there
    from.
    Solemnly affirm and signed before me in this date.
    Date..- Signature of person giving the Declaration/Affidavit.

    Place :-Parlakhemundi Name . …………………………………………………

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