AFFIDAVIT FOR CHANGE OF NAME

(HUSBAND TO WIFE)

I Mr./Mrs./Miss agent resident of

Occupation hereby solemnly affirm oath below:

1. That my Husband (late Mr. Ram Babu Sahu) had a HP Gas Connection from,
Raghubar Gases, 16256700 and subscription Voucher (SV) No. undefined dated
06/12/2014 (details may be obtained from the distributor if the SV is lost)
2. That My Husband late Mr. Ram Babu Sahu has expired on
3. That I request M/s Hindustan Petroleum Corporation Ltd. To transfer the
aforesaid connection in my name and allot me fresh consumer number.
4. That I indemnity M/s Hindustan Petroleum Corporation Ltd. And Raghubar
Gases, 16256700, from any future claims raised by anybody in respect of the
above requested change of name in HP Gas connection.
5. That in the event of my claim whatsoever, raised by anybody against the
transfer of above referred connection in may name. I shall immediately
surrender the equipment issued to me in respect of the above request to M/s
Hindustan Petroleum Corporation Ltd unconditionally.
 6. That I also confirm that I or any member of my family, as detailed in my ration
card, do not posses any LPG connection from any Oil Company.
7. That the original subscription Voucher of Mr. Ram Babu Sahu is surrendered
herewith.
Or
8. That the original subscription Voucher of Mr.Ram Babu Sahu is lost/misplaced
and is not traceable. If it to M/s Hindustan Petroleum Corporation Ltd
unconditionally.
9. That there are no more legal heirs of late Mr. Ram Babu Sahu other than those
appending their signature below. Solemnly affirmed by the within named at on
the day of
Signature we do not have any objection for transferring the HP Gas connection from
late Mr. Ram Babu Sahu to Sri/Smt./Ku. As requested above.
Name Signature
1.
2.
3.
Verification
Verified that the contents of above point 1 to 9 are true and correct to the best of my
knowledge and belief. I am liable u/s 193, 1999, 200 of Cr.P.C./I.P.C. if any contents
found false.
Deponent