AFFIDAVIT

I .. Son/Daughter/Wife of .
and resident of ..
affirm as under :1. That I am an Indian national.
2. That I am residing at ..
(Address) & enclosing a copy of Ration card/Electricity bill/ Rent receipt/ LIC
policy/ Flat allotment letter/House registration paper as a residence proof.
3. That I am also enclosing a copy of pan card/ Driving Licence /Passport/ Voter
ID/ other photo identity issued by State/Central Government as a proof of
identity & date of birth.
4. That whenever I change my residence from present address to another, I will
inform my Indane distributor in Writing for change of address in his record
and complete necessary formalities as prescribed by IOC in his regard.
5. That I confirm that I am not in possession of an LPG connection from any Oil
Company or a Piped Natural Gas Connection or Piped LPG connection for my
domestic use either in my name of any of my family members (husband, wife,
unmarried children and dependent parents) who are residing with me in my
house.
6. That I confirm that the LPG connection issued to me will be used in my above
mentioned address only for authorized purposes as advised by IOC or
competent authority from time to time. I am also aware that domestic LPG
supplied by Indian oil corporation and/ or its authorized Indane Distributors
can presently be used only for domestic cooking purpose.
7. That I shall not position any other LPG gas installation in the same kitchen.
8. That when second cylinder is issued to me I will use the same in the same
kitchen on the original installation only.
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9. That if any information /declaration given by me in this affidavit or any
document submitted in support of Identity/date of birth/residence proof shall
be found to be untrue or incorrect or false, Indian Oil Corporation and/ or its
authorised indane distributors would be within their rights to withdraw/the
supply of Gas/Terminate/seize the LPG equipment & that I would have no
claim, whatsoever against the Indian Oil Corporation and/ or Its authorised
Indane Distributors for such withdrawal / Termination /Seizure.
I hereby verify and confirm that what has been stated above is true to the the best of
my knowledge, correct and nothing material has been concealed there from.
Solemnly affirmed and declared before me this . Day of
Signature & Seal of
Notary Public

Signature of person make

Affidavit