PS – 56
For Exchange of other company cylinder
(To be executed on stamped paper for amount as applicable for affidavit at the place of execution & attested by Notary Public)
- I, __________________________ son/wife of __________________________ resident of ________________________________________ hereby solemnly affirm & state as under:
That I have submitted the prescribed application form to M/s Premier LPG Ltd, New Delhi, through their Dealer M/s _____________________________ at _______________________________ for providing me LPG Refill service, in place of the existing cylinder provided to me by my erstwhile supplier M/s ________________________________.
- I swear & state that all the information & statements furnished by me in my application are true & correct to the best of my knowledge & belief.
- I further swear & state that the erstwhile suppliers named above have stopped refill supplies to me long ago. They had neither returned my security deposit nor taken back their cylinder, despite my demands to them. They have long back closed their business long back at this place & all other known places. Their present address & whereabouts are not known to me.
- I am voluntarily & willingly applying for a new connection from M/s Premier LPG Ltd. & I am surrendering the old cylinder to them at my own free will.
- I agree & undertake to abide by the terms & conditions applicable to all consumers of M/s Premier LPG Ltd.
Signed on this ______ day of _______ 20______.
THE ABOVE CONTENTS ARE TRUE & CORRECT TO THE BEST OF MY KNOWLEDGE & BELIEF & NOTHING HAS BEEN CONCEALED THEREIN.