AFFIDAVIT FOR LOSS OF SUBSCRIPTION VOUCHER

I ABDUL SATTAR S/o ABDUL MAZEET MISHTRI Aged 49 Years an Indian

Inlibatant Resident of PANI KI TANKI KE BAJU ME, MAZEET MISHTRI SAGAR
KRISHNGANJ Madhya Pradesh 470001 Do here by Solemnly Affirm and state as follows
1.
That I am Consumer of HP Gas for domestic use at the above address Since
25/04/1998 my consumer number is 600962
I was issued with subscription voucher No. 1031636 dated 25/4/1998 by M/s
Hindustan Petroleum Corporation Ltd. through HP Gas Distributors M/s Aditi Gas Agency
11053700 Towards a gas cylinder and regulator on loan for my use against the refundable
deposit of Rs. 1,000.00
2.
That I am not able to produce the subscription Voucher to obtain the Termination
Voucher, as it is misplaced/ lost.
3.
That I Shall be liable to M/s Hindustan petroleum corporation limited or the
distributor for any loss or expenses incurred by them if any one else produce the above
referred subscription voucher to claim any amount of other benefit from M/s Hindustan
petroleum corporation Ltd. or their distributors.
Solemnly Affirm by the within named
At ...................... on this ................day of

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Deponent
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Signature
VERIFICATION
Verified that the constants of above paras 1 to 3 are true and correct to the best of my
knowledge and belief.
Deponent