XIX.

Affidavit for compromising of debt repayment

I ____________ S/o _____________ age ______ residence of ______________
hereby solemnly affirm and say as follows. :-
(1) That I am Director of M/s. _______________________ located at _____.
(2) That my above unit is registered as medium scale industries/ small scale
industries with __________________.
(3) That I hereby declare and affirm that my above unit remained
incomplete/never came in commercial production due to following
reasons*:-
(a) Lack of working capital.
(b) Lack of term loan tie up.
(c) Lack of power.
(d) Lack of raw material.
(e) Labour problem in very initial stage.
(4) That I also undertake that my unit falls under category _____
of ___________ OTS policy meant for _____________ units.
(5) That we are agreeable for settlement of dues of our above company namely
M/s.________________ under One Time Settlement. We are agreeable to
pay the principal amount disbursed to us/such amount as is calculated under
your OTS scheme 2004 as applicable in my case which false under
category_____________ of your scheme, as One Time Settlement for all the
dues against the company on account of _________________________.
(6) That as a token or sincerity we hereby deposited the above affidavit along
with 50% of the principal amount/OTS amount of Rs. ______ lacs. Vide
D.D. No.________________ dated._______________.
(7) That if we fail to pay the balance to 50% within the stipulated time as given
by ____________ then in that case the above amount of Rs. ________ lacs
paid by us shall be deposited/ accounted for only against the principal.
(8) That my failure to pay the dues shall entitle ______________ to take action
as it deems fit and proper including filing of case under ___________.
(9) That in no case we shall claim any refund of any amount from _______.
(10) That I shall furnish all such information/papers as are required
by _____________ in connection with this OTS.
(11) That OTS shall not be claimed as matter of right and Managing Director’s
decision on any point of dispute shall be final & binding.
(12) That notwithstanding anything mentioned above, the ________ retain the
right to proceed with any coercive action including those under SFC Act.
(13) That all the above information is correct and if found to be untrue. I shall be
liable for prosecution as per law.
* Score out which ever is not applicable
Deponent
To be executed by the applicant on Non-Judicial stamp paper Rs. 10/- and to be
attested by Notary public).
Verification:
Verified at ____________ this _______________ day of ________________
that the contents of the above affidavit are correct to my knowledge and belief.
Nothing contained herein is untrue and no material is concealed there from.
 Deponent
Sworn and signed before me on this ________ day of
at _________________. Deponent

Seal Attested/Notary
Dated