BEFORE THE EXECUTIVE MAGISTRATE: BHUBANESWAR

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 follows:
1. That, I am the deponent of this affidavit.
2. That, I will supervise, control the sale, distribution and will be responsible for the
preservation of drugs in the premises of M/s NARAYAN DEVICES PVT LTD, Address
Plot No 778, At- Panchasakhanagar, Dumduma, Near ITER Engineering College, Po/Ps-
Khandagiri, Bhubaneswar, Odisha 751030.
3. That, I am not engaged anywhere elsein any Govt/Semi Govt/Private organization in
the capacity of a competent person.
4. That, this affidavit is required to be submitted before the Licensing Authority,
Bhubaneswar, Odisha.
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: Executive Magistrate, Bhubaneswar

Date: