Annexure D:Affidavit by transferee kin of deceased with submission of copy of death Certificate (Transfer of Connection in case of Death of Customer)

Annexure D
FORMAT FOR AFFIDAVIT
To,
M/s ( Name of OMC)
Dear Sirs,
I Mr. / Mrs. …………… son/daughter/wife of Mr ……………. aged …. years, residing at ……………………………………………………….. hereby solemnly affirm as under:
That my ____________________(relation with the connection holder) was in possession of LPG connection from M/s _____________________________(name of distributor of OMC) vide SV no._____________dated_____________Consumer No. _______________.
That Shri/ Smt____________________________________ has passed away on __________________. Attested copy of the death certificate is enclosed.
That I being the ___________________(relation of the next of kin) request that the LPG connection may be transferred in my name.
I confirm that I am agreeable to submit the documents required for the same and to pay the deposit for the equipment as per your terms.
I hereby undertake to indemnify M/s IOC/BPC/HPC against any claim by any other person at a later date with regard to the transfer of the said LPG connection in my name.
SIGNATURE
NAME
Date:
Place: