BEFORE THE NOTARY PUBLIC: CUTTACK

AFFIDAVIT
I, Shri Sanjay Kumar Samantaray, aged about 36 years, S/o- Biswanath Samantaray,
resident of, Longhar, Srikrushnasaranpur, Panditgaon, Khallikote, Ganjam, Odisha 761029
do hereby solemnly affirm and state as under:
1. That, I am the deponent of this affidavit.
2. That, after obtaining Drugs License if I propose to market/sale by way of wholesale any
drug which being sold for the first time in the state of Odisha, the sale will be reported
to the Licensing Authority, Odisha Bhubaneswar/Drug Inspector, Bhubaneswar-II
range, Bhubaneswar.
3. That, I will also furnish the price list in Form-V, as per D.P.C.O 1995 in the Office of
the Drugs Inspector.
4. That, this affidavit is required to be submitted before the Licensing Authority, Odisha,
Bhubaneswar/ Drug Inspector, Bhubaneswar-II range, Bhubaneswar, Dist-Khurda for
necessary action at their end.
5. That, the facts stated above are true and correct to the best of my knowledge and belief.
Identified by

Advocate Deponent
Certificate
The above named deponent being identified by ______________________, Advocate
solemnly states and affirms before me that the facts stated above are true to the best of
his knowledge and belief.
Place: Cuttack Notary Public, Cuttack
Date: