Loss of SV
Loss of SV
Loss of SV
(To be typed on non judicial stamp paper of appropriate value as applicable in the State of living)
1. That I am / was a consumer of HP Gas for domestic use at the following address
2. That I was given the gas cylinder(s) and a regulator when I was residing in ___________.
Thereafter, I shifted to my above mentioned residence.
3. That I want to return the Subscription Voucher along with the cylinder(s) and regulator as
I am shifting my residence from this town and want to terminate the agreement with the
above mentioned Corporation.
OR
That I want to terminate the agreement with the above mentioned distributor.
4. That I am not able to produce the Subscription Voucher along with the cylinder and
regulator to obtain the refundable deposit as it is misplaced / lost.
OR
That I am not able to produce the Termination Voucher as it misplaced / lost.
5. That I have not assigned or transferred the Subscription Voucher / Termination Voucher
to any person whomsoever.
7. That I shall be liable to M/s. Hindustan Petroleum Corporation Ltd. for any loss or
expense incurred by them if any one produces the above referred Subscription Voucher /
Termination Voucher to claim any amount from the Corporation.
Deponent
at ____________________on this ___________ day of ________________
Signature: _________________