Affidavit cum Indemnity Bond Format

I, _________________________________ son/daughter/wife  of ________________ Resident of _________________/ in occupation  of  property  bearing  No. ______________

hereby declare and undertake as follows:


I, _____________________________________________ (authorized representative/tenant) came into the possession of the said premises vide sale deed dated _______________ / Rent Agreement dated ________________ / Lease  Deed  dated  ____________________,  hereby declare  and  undertake:  I  am  in legal and valid occupation of the property since _______ _______.

  1. That I am the owner/lawful occupier of the premises bearing No. ____________________ (address). The said premises  has  been  purchased    by    me/taken    on    rent    by    me    from    Mr.____________,    s/o    ___________, r/o_______________, vide sale deed dated/lease/rent agreement dated ____.
  2. That I have applied  to _____________for grant of a new electricity connection  and to recognize me as the registered consumer in respect of the said connection at the said premises  in the name of Mr./Ms.  ________________(name  of applicant)  on _____________ (date) _____________ vide  request  no _____________________, for a  load of __________KW. I undertake to supply all such documents as may be required by _______________ in that regard and to fulfil all prescribed formalities.
  3. I expressly understand that for grant of new connection in my favour, certain documents have to be furnished and submitted to _________ for further processing of my request in compliance of applicable rules,  regulations.  However, the  address  mentioned  above  does  not  bear  a  clear  municipal  address OR any other clear demarcation which is contained in any ownership document/ title document OR I do  not  possess    Ownership  Documents,  Title documents with respect to the above premises at presently under my occupation.
  4. I state that  I possess   a valid Voter’s Identity Card issued by Election Commission of India/Driver’s license/ration  card  (mention  document  number  ,  details  etc./  License  number  /date  of  issuance) which is valid till __________(date). (A copy of the same attested by Notary public is enclosed.  I also state that I have another connection  for electricity vide K. No._____________,  in ___________ distribution area which is energized  and installed at ______________ (premises address) OR /disconnected since the year ________.
  5. That  if  the  new  connection  requested  by  me  is  granted  ,  I  undertake  to  provide  any,  all    such  documents   to ___________ as   may   be   required   by   them   from   time   to   time   as   proof   of   my Annex. I  affirm  that  there  is  no other  claimant  to  the ownership of the aforesaid property and that the grant of the new electricity connection in my name and recognizing me as the registered consumer with regard to the same does not confer any right of ownership or title to the property in my favour.
  6. That I also undertake that as and when the ownership documents /Title Deed/Rent Agreements etc. are available in my name  OR (in cases of mutation of property pending — ownership documents are transferred in my name/favour) , I shall submit the copy of the said documents with _____________. However,  I   unconditionally   undertake   to   keep _________________ /its   officers   indemnified      against   any losses/damages/risks/liabilities/claims/prosecutions/fines/levies/compensations/proceedings which _________________ may be subject to or be made  liable for or made to suffer  as a result of grant/release of  the new electricity connection on the basis of this undertaking cum indemnity bond including any legal or other  expenses  reasonably incurred  by ___________ in  defending itself/its  officers  as  well  as  for the cost / compensation(s) to which ________ may be subjected to, under any law or pursuant to directions of  any  court/tribunal/authority  ,  if  any,    as  a  result  of  my  failure  to  comply  with  the  terms/conditions  of  this  Affidavit  cum  indemnity  bond,  any  act  of  forgery,  any  material  concealment  of information,  as well as those of any other relevant documents required to be executed by me in this behalf  or  attributable   to  false  /wrong  information  furnished  by  me   in  respect  thereto.  This indemnification  shall  be  without  prejudice  to ________’s right to disconnection of electricity at the above premises and initiation of appropriate legal proceedings.
  7. I undertake that no court case or litigation in respect of the above premises is pending adjudication before any Court of Law/Forum. OR ( I   state that  case no. ______________, titled Mr.”x”  vs. Mr. “Y” is pending in Civil/criminal/revenue court).
  8.  That  without  prejudice  to  its  rights, _________ may  release/sanction the  new  electricity  connection,  as applied,  in  my  favour  in  the  aforesaid  property/premises.  Grant of  this  new  connection  shall  not absolve me from obtaining or getting the ownership/title documents in my name as referred above. _________ reserves  the  right  to  disconnect  the  electricity  supply  at  any  point  of  time  against  the  new connection, on my failure to comply with the above terms and conditions of this bond.
  9. I declare that the contents of this Bond are true and correct and further that in case any /all of the above information is found false /incorrect, _______ shall be entitled to forthwith disconnect the new connection  granted  at  said  premises  and  initiate  appropriate  legal  proceedings  against  me.  ____________ may also demand such amounts of additional Security deposit from me from time to time as ______ may  deem  fit  as  a  safeguard  for  securing  any  event  of  non  payment  on  my  behalf. _________ may without  prejudice  to  its  other  rights,  also  transfer  the  dues  towards  the  new  connection  if  remain unpaid, to my other connection (details furnished above).
  10. I solemnly confirm that in case of any dues arising against the connection granted to me against notification no._____________ may be transferred to CA no/Kno.______________.
  11. That  I  undertake  to  provide  such  documents  to _______ as may  be  required  by them  as  proof of my ownership/possession/occupation of the property. However in case of any loss, damage having been caused to _____ I shall unconditionally indemnify ________ as provided in clause 6 above.
  12. I undertake that by completion of the required formalities &  paying the applicable charges for new connection does not  confer any right  on me  for the grant  of new connection.  By  grant of the new electricity   connection in my name/favour on the basis of this Bond, ______ does not guarantee that the  requisite  formalities  in  respect  of  ownership  /Title  documents/  land  usage requirements  have been complied by me.



Verified  at  ____________  on  this  __________________day  of_____________  2015  that the  contents  of  the  above affidavit  are  true  and  correct  to  my  knowledge  and  belief  and  that  nothing  material  has  been  concealed there from.  


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