FORMAT FOR TRANSFER AUTHORIZATION OF SAFE CUSTODY TV

I hereby transfer my claim of domestic LPG connection against “Safe Custody TV for PNG consumer” number ____________ dated _________ to Mr/Ms _________________ who is related to me as ______________________, and signature is attested below.
I am handing over both the copies above said Safe Custody TV for PNG consumer along with this letter for availing domestic connection. I shall have no claim whatsoever against this Safe Custody TV.

Signature and name of person to whom
Safe Custody TV is transferred
Signature of holder of Safe Custody TV for PNG consumer
Date ________
Place ________