AFFIDAVIT

I _________ Son/Daughter/Wife of _________ resident of _________ do solemnly affirm and state a follow:

1.    I do not possess a ration card and am producing _________ Bill/_________ letter or any other as proof of my residence.
2.    I am not an existing LPG/PNG connection from any Oil Company/OR and will not possess one, in future in the same premises/Household.
3.    I have received the “_________” Instruction Card and agree to follow such instructions given by you from time to time.

Deponent

VERIFICATION:

Solemnly affirm by the within Name _________  at _________ in this _________ day of _________, _________ that paras _________ are true to my knowledge.

Deponent