AFFIDAVIT / DECLARATION FOR TRANSFER OF

G-D

AFFIDAVIT / DECLARATION FOR TRANSFER OF GAS CONNECTION IN APPLICANT’S NAME

(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 applying for transfer of the Domestic LPG / Commercial LPG / PNG (Piped Natural Gas) / any other gas connection presently standing in the name of Shri / Smt. …………………………………………, S/O, W/O, D/O …………………………………………………….

2-That the said gas connection is with M/s ………………………………………….....………………………………, District …………….....……, vide SV No./Connection No./Consumer No./BP No./CA No. ………………………………………, dated …………………….

3-That the present consumer / connection holder Shri / Smt. ……………………………………………………… is alive and has given his / her full consent / no objection for transfer of the said gas connection in my favour.

4-That I request you to transfer the said gas connection in my name and to treat me as the lawful consumer thereof.

5-That I undertake to complete all required formalities and to submit all documents as may be required by the concerned gas company / distributor / service provider for transfer of the said connection.

6-That I also undertake to pay security deposit / transfer charges / equipment charges / outstanding dues, if any, as may be applicable under the rules.

7-That after transfer of the said gas connection in my name, I shall abide by all the terms and conditions of the concerned gas company / distributor / service provider.

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

Date: ………………..

Place: ………………

DEPONENT

Signature: …………………………………

Name: ………………………………………