I _________ son/daughter/wife of _________ resident of _________ do hereby Solemnly affirm and declare as under:-
1. That I am citizen of India.
2. That my permanent address is _________.
3. That I have only one Gas Cylinder on my Connection (Connection No. _________ & Booking No. _________) & want to apply for Second Cylinder From Your Gas Agency (_________ Gas Service/Agency).
4. That this is my true Statement.
Verified at _________ 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.