AFFIDAVIT

To,

M/s. National Gas Service,

Wadala (E)

Pin -421 503.

Dear Sirs,

I Mrs. Ratnaprabha Sakharam Bhagwe wife of Mr. Sakharam Bhagwe aged 61

years, residing at Flat No. 203, Shri Gurudham CHS; Dattawadi, Badlapur (E)
hereby solemnly affirm as under:

That my husband (Shri. Sakharam Bhagwe) was in possession of LPG connection

from M/s Ajinkya Gas Service (name of distributor of OMC) vide SV no. 175562
dated12.07.1986, Consumer No. 32499

That Shri. Sakharam Bhagwe has passed away on 17.05.2012 Attested copy of the
death certificate is enclosed.

That I being the ___________________(relation of the next of kin) request that the
LPG connection may be transferred in my name.

I confirm that I am agreeable to submit the documents required for the same and to
pay the deposit for the equipment as per your terms.

I hereby undertake to indemnify M/s IOC/BPC/HPC against any claim by any

other person at a later date with regard to the transfer of the said LPG connection in
my name.
SIGNATURE

NAME: Ratnaprabha Sakharam Bhagwe

Date: 19.12.2013

Place: Badlapur