AFFIDAVIT CUM DECLARATION

Before the Executive Magistrate at Siliguri.

I, UDAY PRAKASH CHOUDHARY,(PAN: AWBPC0222B), (Aadhaar-6408-2917-9349), (Voter Card No-GLQ4760880),

S/o. Late Nand Kishore Choudhary, residing at Bishwakarma Mandir Road, Khalpara, within Ward No. IX of Siliguri
Municipal Corporation, Post Office and Police Station – Siliguri, District – Darjeeling, Pin- 734005, in the State of West
Bengal, Indian by nationality, Hindu by religion, Business by occupation, do hereby solemnly affirm and declare as
follows:-
1. That I declare, I , am dropping the online application(2020-21/04/000145) for excise License for FL ON SHOP
with mother licence of RESTAURANT CUM BAR with correct information and documents, Bank counterfoil
LDCC with counter signature of Bank Manager, Copy of cancelled cheque which are true to the best of my
knowledge and belief.
2. That I declare, if any of the documents/ information furnished against the cancellation of online application for
Refund process of security deposit and other necessary fees for carrying out the business of FL.ON SHOP with
mother licence of Bar & Restaurant, if found false, the process of refund shall be liable to be cancelled by
competent authority.
3. That due to being engaged in other activities and not being able to devote time to carry to continue the business of
FL ON SHOP with mother licence of RESTAURANT CUM BAR ,and the time to commence with established pre
recorded address within the determined time frame,for which an application is made shall be treated as an
application for refund .
4. That I am swearing this Affidavit in order to prove and declare the above contents/statements.

That the statements made above are true to the best of my knowledge and
belief and I sign this AFFIDAVIT CUM DECLARATION on this the 7 th
day of Mach 2024 at Siliguri.

UDAY PRAKASH CHOUDHARY

Declarant

Identified by me

Advocate, Siliguri