I _________ Son/Daughter/Wife of _________ resident of _________ do solemnly affirm and state a follow:
1. I do not possess a ration card and am producing _________ Bill/_________ letter or any other as proof of my residence.
2. I am not an existing LPG/PNG connection from any Oil Company/OR and will not possess one, in future in the same premises/Household.
3. I have received the “_________” Instruction Card and agree to follow such instructions given by you from time to time.
Solemnly affirm by the within Name _________ at _________ in this _________ day of _________, _________ that paras _________ are true to my knowledge.