AFFIDAVIT

Strike out whichever is not applicable

I, Shri _______________ major of age, son of Shri. ____________________ resident of

___________ Goa do hereby state under solemn affirmation that I am a sole owner of
the house/flat __________in which there exist an electrical connection no._________ in
the name of installation No.______ in the name of Shri.

1. a) I have purchased the said house/flat by sale deed dated___________

registered at _________

2. I am married to Shri/Smt.____________________ son/daughter of Shri./Smt

______________ who is my husband/wife/father/mother in whose name the
electrical installation stands.

3. I say that there are no legal heirs having any ownership rights on the said
premises.

4. The No objection certificate attached is from _____________.

5. This affidavit is made in order to enable me to change the name if the

consumer from __________ to my name _______________ for electric connection
No.______________

Installation no.______________ at the house /flat no.______________.

6. In case of any dispute regarding ownership of the above referred premises/or

in case any of the above statements are proved to be false the Assistant
executive Engineer,S/D-II, Margao is free to change the name of the
consumer of the above referred installation back from my name to Shri/Smt.
_____________.

7. No part of this affidavit is false or misinterpreted nor is any

evidence/information regarding ownership rights of any other
person/concealed.

The Deponent

Date:

Date: