AFFIDAVIT

1. I/We __________________ S/o, D/o, W/o

Res. /Off

Do hereby solemnly affirm and declare as under:-

That I have purchased the
Bearing Registration Chassis No.
Engine
No. ,
Model No. From
Mr. (Insured Name)
S/o, D/o, W/o_
Res/Off
2. THAT I have received complete physical possessi on of the
vehicle and I am satisfied with the condition of the vehicle.
3. THAT I con fir1n that henceforth the seller shall not bold
any acc0Lu1tabili ty towards the vehicle .
4. THAT Ia1n fu lly aware that the veh icle, bei ng sold to me,
had met with an accident and hence it is sold to the as
salvage on as is \where is basis.
5. THAT I am purcha sing the vehicle wi th utn1ost
consciousness and I am under no duress, threat or
coercion from anybody \whosoever.
6. THAT I have been fu ll y explained about the veh i cle, i ts
cond i tion an d there has been no misrepresentation or
concealment of facts to me.
7. THAT I have purchased the above sa i d veh icle a nd I sha ll
be fu ll y responsible for all ki nd s of legal, statutory or
non -statutory l iabi li ti es, i ncl uding but not l i m i ted to
challans, taxes, accident etc. for the above men ti oned
Veh i cl e from the date of purchase, 1.e.
THAT I hereby expressly hol d myself responsibl e for
transfer of ti tle of the vehicle in any name and to accord the
change of ownership record with the appropriate auth orities.

DEPONENT
Verification:
I, the above
named deponent do hereby verify on oath that
the contents of the affidavit above are true to my
personal knowledge and nothing ma terial has
been concea led or falsely stated. Verified a t
This day of

DEPONENT