AFFIDAVIT / DECLARATION FOR TRANSFER OF

G-C

AFFIDAVIT / DECLARATION FOR TRANSFER OF GAS CONNECTION BY EXISTING CONSUMER

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

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 I am the present 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 I am alive and competent to make this declaration and the said gas connection is presently standing in my name.

3-That I have voluntarily decided to get the said gas connection transferred in favour of Shri / Smt. ………………………………………………, S/O, W/O, D/O ……………………………………………………, resident of ………………………………………………………………………………………………………, District ……………………………….

4-That I have no objection whatsoever if the above-mentioned gas connection is transferred in the name of the said Shri / Smt. ……………………………………………………….

5-That I further declare that I shall have no claim, objection, dispute or demand in future regarding the said gas connection after its transfer in the name of the above-mentioned person.

6-That in case any document, formality, security deposit adjustment, transfer charge or any other requirement is necessary for such transfer, I am willing to comply with the same as per rules of the concerned gas company / distributor / service provider.

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

Date: ……………………………

Place: …………………………

DEPONENT

Signature: …………………………………

Name: ………………………………………