Loss of Receipt Affidavit
I, ____ SON OF ____ RESIDENT OF ____, do hereby affirm and state under oath as follows:-
1. That I am a ____ at the above address since ________, my consumer No. ____. I was issued with Receipt/Subscription Voucher No. ____, dated ______ distributors ______ towards _____ and ____ for my use against the refundable deposit of _____ / delivery of product ____.
2. The I am not able to produce the Receipt/Subscription Voucher to obtain the Termination Voucher, as it is misplaced/lost.
3. That I shall be liable to _____ or the distributor for any loss or expenses incurred by them if any one else produce the above referred Receipt/Subscription voucher to claim any amount or other benefit from _____ or their distributors.
Solemnly affirm by the within named
At _____, on this ____
Verified that the contents of my above para 1 to 3 are true and correct of the best of my knowledge and belief. I am liable u/s ____ of ___ IPC if any contents found false.