Draft

AFFIDAVIT FOR CANCELLATION/SURRENDER OF GS1 INDIA

SUBSCRIPTION FOR BARCODE NUMBERS
(To be provided on stamp paper worth Rs. 10 or more)

I s/o , Sole Proprietor/ Partner / Director of the

_ (name of business/company/ firm), am fully
conversant with the affairs of the business/company/ firm. And as such I am
competent to swear this affidavit on behalf of (name of business/company/
firm) and do hereby solemnly affirm and declare as under, that:

We would like to cancel/surrender our subscription of GS1 India barcode

numbers and hereby relinquish the right to use these barcode numbers
allocated to us by GS1 India. The particulars of our business/company/ firm
are:

1. GS1 India barcode subscription number:

2. Company name:

3. Company address:

4. Contact person:

5. Designation:

6. Reason for cancellation /surrender:

We hereby submit that our GS1 India barcode subscription number

was valid till _. We further affirm that we
are not using, have not used/sub-let, and will never use/sub-let GS1 India
barcode numbers on any of our products beyond this validity date.

We ensure the withdrawal of our products using GS1 India barcode numbers
from retailers/e-tailers/distribution network, after surrender/cancellation of
our subscription. We also ensure delisting of our products from retailers’ and
e-tailers’ item masters after surrender/cancellation of our subscription.

We are aware that after surrender/cancellation of our GS1 India subscription,

our product data will not be visible through any GS1 owned/powered
platforms, including DataKart, Smart Consumer mobile app, GEPIR, and GS1
Global Registry.
We agree that any unauthorised use of GS1 India barcode numbers by us and
violation to any “Terms of Use” of GS1 India Allotment Letter for barcode
numbers will attract penalty and we would be liable to pay for damages/loss
to GS1 India & any of its subscriber(s). We also agree that unauthorised use
of GS1 barcode numbers would invite legal action against us by GS1 India at
its sole discretion.

We further acknowledge and agree that in case we wish to use GS1 India
barcode numbers in future, we will apply afresh and pay full requisite fees to
GS1 India, as applicable then.

(Signature with Name & Designation)

DEPONENT

VERIFICATION

It is verified on day of , that the above mentioned facts are true

and correct to the best of my knowledge and nothing has been concealed
therefrom.

(Signature with Name & Designation)

DEPONENT