LOST TV
(ON Rs. 100 COURT FEE STAMP PAPER)
AFFIDAVIT
Annexure-2
I _________________________ aged ________________________ years an Indian inhabitant residing at ______________ do solemnly affirm state as under:
1. That I had an Indane gas installation at ______________ in my name and my consumer number was ______________
2. That I returned the gas cylinder and regulator to Indian Oil Corpn. Ltd./Indane
Distributor M/s. --------------------on ____
(Name and Address) (Date)
--------------(Reason)
3. That Indian Oil Corporation Limited/the said Distributor M/s. ____________________ refunded my deposit of Rs. _________________paid by me towards the cylinder and regulator and issued to me the Termination Voucher Number dated ____
4. That the referred Termination Voucher has been lost by me.
5. That I have not availed of any L.P. Gas Installation in my name at any place in India either from Indian Oil Corporation Ltd., or from any other gas marketing company in India by using the above referred Termination Voucher.
6. That I undertake to return forthwith the above referred Termination Voucher to Indian Oil Corporation Limited, Bombay-400 051 if found at any time in future.
Solemnly affirm by the within named __________________ at _____________ on this ____________ Deponent day of ___________________ 19 ______ Before me