UNDERTAKING

::::NO DUES PAYABLE AGAINST ELECTRICITY BILL OF APDCL::::

I, …………………………………………….....................………… LDA/UDA/Sister/Tutor/

Pharmacist/ANM/Staff Nurse/Health Educator/Vaccinator/Dresser/Peon/Grade-IV/ Other (…………..

………………………………………) of
…………………………………………………………….SC

/PHC/BPHC/CHC/Model Hospital/MCH/GNM TS/Jt. DHS Office under the establishment of

Joint Director of Health Services, Darrang have not any electricity connection of APDCL under
my name. The Electricity Bill of my houses is in the name of Mr./ Mrs.
………………………………..

……………………………, who is my father/ mother/father-in-law/

spouse……………………………

His/ Her Consumer No. is ………………………………………………….. and the last monthly bill
of

Rs. ……………………………../- was already being paid on …….…./ ………../2021 vide Receipt
No.

…………………………..………….& invoice No. …………………………..

Now, I hereby certified that there is NO DUES PAYABLE AGAINST ELECTRICITY

BILL OF APDCL in the name of myself, my spouse or any dependent.

Date ………../………../ 2021

Place ……………………….

Yours faithfully

Sign: ………………………………

Name: ……………………………..

Designation: ………………………

Mobile No: ………………………..