On Rs.

100 Stamp/e-stamp paper

AFFIDAVIT

I, (Name of the Proprietor/ Partner/ Director), son/daughter/wife of (Father’s/

Husband’s name), R/o- (Complete address with PIN code), do hereby solemnly affirm
and declare as follows:-

1. That I am the (Proprietor/ Partner/ Director/ Authorized Signatory) of (Name of

the Unit, complete address of the Unit with PIN code).
2. That at no point in the past, the (individual/ firm/ company) promoting the Unit,
were black listed by the government (state or central).
3. That at no point in the past, the individual/ firm/ company promoting the Unit, has
defaulted on any loan availed from any bank or Financial Institutions (FIs).
4. That the individual/ firm/ company promoting the Unit has no dues payable to
government.
5. That there is no public sector investment in the Unit either by the Central
Government or any State Government.
6. That I have not availed any Incentives against the proposed unit, nor availed any
incentives against the land on which the Unit is proposed to be set-up, under
Industrial Incentive Policy, 2011 or any previous industrial policies.
7. That I have not availed any Incentives against the proposed unit under any other
Scheme of the Central Government or State Government of Bihar except as
permitted under Bihar Industrial Investment Promotion Policy and duly intimated
to the SIPB Secretariat.
8. That I undertake that variation or change in above declaration, if any, shall be
intimated to SIPB secretariat immediately.

Deponent

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