AFFIDAVIT FOR TRANSFER OF GAS CONNECTION

G-A

AFFIDAVIT FOR TRANSFER OF GAS CONNECTION AFTER DEATH OF CONSUMER

(For Domestic LPG / Commercial LPG / PNG (Piped Natural Gas) / Any Other Gas Connection)

Annexure-D

To,

M/s ………………………………………………………,

………………..........……… District ……..............….

Dear Sir/Madam,

I, ……………....................………, aged........ years, S/O, W/O, D/O….………………………, resident of ………………….......................…………………………………………………, District ……………………..…, do hereby solemnly affirm and declare as under:

1-That my………………………………………………………….....…… S/O, W/O, D/O ………………………..…………………………, was the holder/consumer of a Domestic LPG / Commercial LPG / PNG (Piped Natural Gas) / any other gas connection with M/s…………………………………………………………………………………………, District…………..……………, vide SV No./Connection No./Consumer No./BP No./CA No.………………………………………, dated…………….……………….

2-That Shri / Smt. …………………………………………………… expired on ……………………. An attested copy of the death certificate is enclosed herewith.

3-That I, being the ……………………………………………. of the deceased consumer, request that the said Domestic LPG / Commercial LPG / PNG (Piped Natural Gas) / any other gas connection be transferred in my name.

4-That I am willing to submit all the documents required for the transfer and to pay the security deposit / transfer charges / equipment charges, if applicable, as per your terms and conditions.

5-That I hereby undertake to indemnify IOC / BPC / HPC / concerned gas company / distributor / service provider against any claim that may be made by any other person in future regarding the transfer of the said gas connection in my name.

6-That the statements made above are true and correct to the best of my knowledge and belief.

Date: ……………………………

Place: …………………………

DEPONENT

Signature: …………………………………

Name: ………………………………………