Affidavit-Cum-Declaration

This affidavit is made on day of February, 2022, by me, for the purpose or
in support of Memorandum of understanding vides no.____________ and
shall be binding upon me and on my successor-in-title hereinafter referred to
as (the "Affiant").

I, Mr./Mrs. ________________, age ______ years, Indian Inhabitant,

Aadhar no. ____________, Pan no. _____________ having residing at
____________________________________________________________
. Hereinafter the “Affiant” do hereby independently / discretely and solely
state on solemn affirmation as under:-

As per the request letter dated _____________ by the Affiant to the Giver
herein the mentioned MOU was made for the extension period and the
terms of the same are mentioned in MOU.
1. I say that a Memorandum of Understanding was made between me and
Mr./Mrs. __________________, an Indian inhabitant Aadhar no.
____________________, Pan no. ___________ (Hereinafter referred to as
("The Giver") from whom I have taken a friendly loan of Rs. __________/-
(________ Only) through cash installments in between __________ to
___________ and for the same the above referred MOU was executed on
_________ at the request of mine.

2. I say that I hereby pledged my property situated at

___________________________________ (hereinafter referred to as "The
Room / Shop "). Admeasuring ______ Sq.ft. as security and is liable to be
forfeiture in the event of failure for payment of preferred loan amount after
the due date along with the compensation thereof as agreed in the MOU.
Hereby annexing the copy of rent receipt and electricity bill of the
room / shop.

3. I say that I hereby indemnify at all times hereafter save harmless and keep
the ‘giver’ indemnified against any and all expenses costs actions
proceedings claims demands penalties damages and liabilities which may
be brought or made against or incurred by the ‘giver’ by reason or on
account of non-observance of all or any of the stipulations on the part of me
contained in the referred MOU or otherwise howsoever owing out of or in
connection with the same. The legal actions of any nature which will be
taken by the ‘giver’ against me the amount / expenses incurred shall be
payable by me for which I am indemnify the ‘giver’. I say that I am aware
about the legal consequences / ramification if any untoward incident occurs
in near future. I am bond for it and ‘giver’ is not responsible about it. In such
event, ‘giver’ shall have the right to institute appropriate Criminal legal
proceedings / Civil legal proceedings against me. And I hereby bond myself
to suffer the consequences of such legal action arising out of the
prospective default on my part i.e. non-payment of the said loan amount
before / on the due date.
4. I say that I hereby undertake that if I failed to pay the loan amount within the
stipulated period as stated in the referred MOU I hereby hold myself or my
heirs / successors-in-title etc to be prosecuted / charged under relevant
criminal as well as civil proceedings as per law and for which I am totally
responsible. Moreover I hereby take an oath for the same in favour of
concerned police station (whenever peruse / inspected by the officer in
charge in relate to referred MOU) to apprehend me and to take forthwith
legal action against me as per law.

5. What has been stated herein above are made out of my own personal
knowledge and belief and the same are true and correct and I have signed
this affidavit-cum-declaration out of my own free will and accord and without
any force, undue influence, coercion and same has been explained to me in
my mother tongue.

Solemnly Affirmed at Mumbai )

This ___ day of February, 2021 )
(Affiant)
WITNESSES :
1. Mr. / Mrs.____________________

2. Mr. / Mrs._____________________

Identified by me,
Before me,
NAME L.H.T.I. PHOTOGRAPH
1. Mr./Mrs.
__________________