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Affidavit From Class 1 Magistrate 2023-24

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Format of Affidavit to be submitted by all the Consumers issued by First Class

Judicial Magistrate
(In Original on minimum Stamp Paper of INR 100/-)
AFFIDAVIT

I, …………………………………………………… aged about ..……….. years, occupation business and


resident of …………………………………………………………….…, do hereby take oath and state on solemn
affirmation as under:

1. I am Proprietor / Director / Partner of M/s ......................................................... , situated


at .............................................................................................. , engaged in manufacturing of
………………………………………………. and I am duly authorized to affirm and sign this
affidavit on behalf of the unit;

2. That our unit is eligible for procurement of coal from State Nominated Agency in terms
of provisions of New Coal Distribution Policy, 2007 read with rules framed three under,
if any including amendments thereof;

3. That we have neither been banned / declared ineligible for corrupt and fraudulent
practices in coal related activities by the Govt. of India / State Governments / any
government authority;

4. That neither any coal related enquiry / disciplinary proceeding has been initiated nor
pending against us / our unit in any court of law / tribunal / government department /
ministry / authority including Central Bureau of Investigation (CBI);

5. That we undertake and confirm that nothing has been concealed from Bihar State
Mining Corporation Limited and all the documents submitted for execution of Fuel
Supply Agreement (FSA) are genuine and shall comply with the terms of FSA.

Hence this is an affidavit.


Signature of Deponent

(Name… ................................ )
Place: …………………………...
Date: ………./… ....... /2023
Authorised Proprietor / Director / Partner of

M/s ……………………………………………………………

Verification
Verified that the contents of above affidavit from Para 1 to 5 are true and correct to the
best of my knowledge, official records of the unit and belief.

Hence verified and signed at …………………... on this ………… day of .................. 2023….

Signature of Deponent

I know and identify the deponent


Advocate Before Me

(Before )

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