CHANGE OF NAME FOR GAS LETTER |CHANGE OF NAME FOR GAS AFFIDAVIT|CHANGE OF NAME FOR GAS FORM

( To be typed in stamp paper as per stamp act )

AFFIDAVIT FOR CHANGE OF NAME

I, _______, aged __ years, resident of ___address__, Occupation : _______, hereby solemnly affirm oath below:

1. That my father (____) had a (HP Gas) Connection from M/s ______ AGENCIES vide Service No. (Consumer No. ____) and Subscription Voucher (SV) No.____ dated ___.            
2. That my father Mr. Seethi expired on _____.
3. That I request M/s (Hindustan Petroleum Corporation Ltd). to transfer the aforesaid connection in my name and allot me fresh consumer number.
4. That I indemnify M/s (Hindustan Petroleum Corporation Ltd). and M/s ______AGENCIES from any future claims raised by anybody in respect of the above requested change of name in (HP) Gas connection.
5. That in the event of any claims whatsoever, raised by anybody against the transfer of above referred connection in my name, I shall immediately surrender the equipment issued to me in respect of  the above request to M/s (Hindustan Petroleum Corporation Ltd) unconditionally.
6. That I also confirm that I or any member of my family, as detailed in my ration card, do not posses any LPG connection from any Oil Company.
7. That the original Subscription Voucher of Shri. _____ is surrendered herewith.
8. That the legal heirs of late Shri.____ have appended their signatures below expressing their No objection for the above requested transfer of the (HP) Gas connection.
9. That there are no more legal heirs of late Shri. ______ other than those appending their signatures below.

Solemnly affirmed by the within named ______ at _____ on the ______.

Signature

We do not have any objection for transferring the (HP) Gas connection from ______ to Shri._____ as requested above.

                                  

	Name	Signatures
1.
2.

 

Verification

Verified that the contents of above para 1 to 9 are true and correct of the best of my knowledge and belief. I am liable u/s 193,199,200 of Cr. P.C. / IPC if any contents found false.

Deponent

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