Self-Declaration

I the undersigned major of age, Indian national,

resident of
In village .in PernemGoa state do hereby
solemnly affirm and
State on oath as under:1 I say that I have constructed the permanent structure in the property
structure in the
Property surveyed under no. in
V.P
2 I say that I have obtained ownership rights of the said
property/structure by the virtue
0f sale deed / succession deed or will of the owner or no objection
issued by all other legal heirs of the property
3 I further say that I have been given no objection in releasing/ taking
electricity connection to the said structure from
V.P.and I desire to
Electricity connection to the same.
4 That I same taking the entire responsibility, in case of any dispute
arises as regards
To electricity connection give to me for the said house from any
individual or public
Authority. I say that I am ready to face the consequences at my own
risk & cost
The electricity connection given to me may be disconnected.
That this affidavit is executed by me in order to produce the sane the (office)
of sub divisional
Engineer, electricity department, Agar Wada Pernem Goa for the purpose of
taking of
Electricity connection for residential/commercial/industrial
at
In V.P

That whatever I have stated above is true & correct to best of my knowledge
and belief.
Place:
Date: