ਆਪਣੀ ਜਾਣਕਾਰੀ ਭਰੋ

GAS CONNECTION TRANSFER AFFIDAVIT

I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. 1. THE CONNECTION

1. 2. REASON FOR TRANSFER

1. 3. DUES

1. 4. SAFETY UNDERTAKING

4.1 I undertake to use the connection only at the premises stated above, for domestic purposes, and to comply with the distributor's safety and inspection requirements. I confirm that the gas stove, regulator and suction hose at the premises have been checked and are safe.

1. 5. DECLARATION

VERIFICATION

DEPONENT

Signature: ______________________________
__________

ATTESTATION

Notary Public / Oath Commissioner
Registration No. and seal: ____________________