DRAFT-AFFIDAVIT (Rs.

10/- Stamp Paper Language)

(For surrender the existing electric connection)

I/ We ………………………………… S/o Sh. …………………………………. resident of

………………………. …………………………………………………………… do hereby
solemnly affirm and declare as under:-

1. The said premises is installed with electricity connection against K.No. ………………….. the name
of ……………………………………………………… and existing electricity connection is to be
surrendered.
2. I shall pay the dues calculated in pre-final bill after disconnection of supply.
3. I under take to make payment if found in due course of time each after issue of final bill if found
payable at a later stage.
4. I under take to indemnity NDMC for recovery of dues not paid by me on said K. No.
…………………….

VERIFICATION

I/We ……………………………………………. S/o ………………..................... resident

of………………………………… …………………………………………………………………..
do hereby confirm that the contents of above affidavit are true to the best of my knowledge and
belief and nothing has been concealed therfrom.

WITNESSES

1.

2.