GAS CONNECTION AFFIDAVIT

I, _____ son/daughter of _____, Resident of _____, _____ do hereby solemnly affirm and declare as under:-

1-    That the deponent is the resident of the above said address.
2-    That  the deponent wants to take the New Gas connection of _____ from the franchisee/distributors _____, at _____, _____.
3-    That no Gas Connection has ever been allotted in the name of the deponent.
4-    That the deponent undertakes that the deponent abides by the all rule and regulations/ terms and conditions of the _____.

Deponent

VERIFICATION:
Verified that the contents of my above affidavit are true to best of my knowledge and belief and nothing concealed therein.
Verified at _____ on _________

Deponent