Annexure B

FORMAT FOR AFFIDAVIT

To,
M/s ( Name of OMC)

Dear Sirs,
I Mr. / Mrs.
son/daughter/wife of Mr . aged . years,
residing at .. hereby solemnly affirm as
under:
That
Mr/Mrs.
.
who
was
residing
at
has left with me your
equipment covered under your Subscription Voucher No. dt.
Since Mr./Mrs . does not intend making us of the said
equipment, I request that the same may be transferred to my name and a fresh
consumer number be given.
S.V.
No.

dt
.
. is herewith surrendered.

Issued

to

Mr.

I confirm that I am agreeable to submit the documents required for the same and giving
you deposit for the equipment as per your terms.
I hereby attach a letter from Mr./Mrs requesting M/s
IOC/BPC/HPC to transfer the connection in my name and also authorizing you to hand
over the deposit amount to me.
I hereby undertake to indemnify M/s IOC/BPC/HPC against any claim that Mr./Mrs
may at a later date make on you in respect of either
equipment or the security deposit covered under your aforesaid S.V. for which deposit
has been refunded to me by you.
Thanking you,
Yours faithfully,

SIGNATURE
NAME
Date:
Place: