Affidavit Sample Document

Template / Example / Draft Affidavit Format for Surrender of BSNL Land line Phone & refund of Security Deposit in word / doc


I, Anil Kapoor, S/o late Ashish Kapoor aged about …… years residing at ……. , do hereby solemnly affirm and state as under :

1.    That I have applied for Land Line connection of BSNL in the year 1995 and BSNL has sent their Invoice No….. dtd…. for Rs.3000/- along with their letter No….. dtd….

2.    That I have deposited Rs.3000/- at the office of BSNL, Mumbai and the receipt was obtained as part of security deposit have got misplaced.

3.    That the detail about the security deposit is visible from the first telephone bill sent by BSNL vide Bill No…… dtd….. for Rs….. . The said bill was paid on …..

4.    That I have made an application for surrendering the land line connection on 21.08.14 and accordingly BSNL has issued letter to that effect vide Ref No…..  dtd. 21.08.14.

5.    In view of above, I have to make an application for refund of security deposit after adjustment of necessary dues against Telephone No. ------- and therefore this indemnity bond is prepared.

6.    I, Anil Kapoor, humbly indemnify BSNL or agent thereof from the security deposit amount of Rs.3000/- being paid to me in lieu of urgent receipt of security deposit against this indemnity bond. Further I state that the original security deposit receipt, if trace and found, no further claim will be made to VSNL in future.

Place : Mumbai

Date : 25.08.2014                                               Anil Kappor


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