Affidavit for Loss of Subscription Voucher


I, _________ Son/Daughter/Wife of _________ Resident of _________, Hereby solemnly confirm and declare:

That I was issued a gas connection at consumer No. _________ Vide subscription Voucher No. _________ dated _________ from M/s _________ Gas Agency.

The said voucher has been misplaced/Lost by me and in the event if it is found, I shall arrange to surrender the same to the corporation/distributor I shall not misuse the said voucher I indemnify _________  and it’s distributor of claim, if any against the above said subscription voucher



Verified at Delhi on this _________  day of _________ that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.


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