I, _________ S/o, D/o, C/o, Mr./Mrs _________ having been admitted to having been admitted to _________, have received a copy of the _________ Regulations on _________, Carefully read and fully understood the provision contained in the said regulations.
1. I have, in Particular, perused _________ of the regulations and am aware as to what constitutes ragging.
2. I have also, in particular, perused clause _________ of the regulation and am fully aware of the penal and administrative action that is liable to be taken against me in case I am found guilty of or abetting, actively or passively, or being part of conspiracy to promote ragging.
3. I hereby solemnly aver and undertake that:
a. I will not indulge in any behavior or act that may be constituted as ragging under clause _________ of the regulations.
b. I will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging under clause _________ of the regulations.
4. I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause _________ of regulations, without prejudice to any other criminal action that may be taken against me under any penal law for the time being in force.
5. I hereby declare that I have not been expelled or debarred from admission in any institution in the country no account of being found guilty of, abetting or being part of a conspiracy to promote, ragging, and further affirm that, in case the declaration is found to be untrue, I am aware that my admission in liable to be cancelled.
Verified at _________ in this the _________ of _________
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has been concealed or misstated therein.
BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, _____
_____ son of _____, resident of _____.
COMPLAINANT
VERSUS
1- _____ son of _____, resident of _____.
2- _____, _____ through its _____.
…..RESPONDENTS
Complaint Under Section _____ of the Consumer Protection Act _____ Amended up to date
Sir,
The complainant respectfully submits as under: –
1- That the complainant purchased _____ drinks marked as _____ on _____ from the shop of the respondent No.1 and out of the said _____ bottles one bottle was drinked by the _____ of the complainant
2- That the respondent No.1 is the retailer /seller of the products of the respondent No.2 and the complainant purchased _____ bottles _____. Each from the respondent No.1 so both the respondents being the seller and manufacturer of the _____ Drinks respectively. Thus the complainant is the consumer of both the respondents as defined under the various relevant provisions of the consumer Protection Act.
3- That the _____ of the complainant after _____.
4- That the complainant sent a legal notice dated _____ to the respondent No.1 calling upon him to release the bills regarding the purchase of bottle and the respondent No.1 gave the said Bill that was as Bill No. _____ dated _____ in favour of the respondent No.1, by _____ Drinks. (Copy of the same is enclosed herewith the complaint).
5- That due to the deficient and wrong service of the respondents the health of the complainant’s _____ was effected and the complainant was mentally and monetarily shocked. The complainant is entitled to receive _____/- as treatment charges of his _____from both the respondents jointly and severally
6- That the complainant is residing at _____ and the Respondent No.1 is doing his business at _____ and the respondent No. 2 is supplying the drinks at _____ at the shop of the respondent No.1 within the territorial jurisdiction of this Hon’ble Forum, therefore, this Hon’ble Forum has got the jurisdiction to entertain and try the present complaint.
PRAYER:
It is, therefore, prayed that in view of the forgoing facts and circumstances this hon’ble court may kindly be pleased to:
i) Pass an order directing the respondents to pay _____/- to the complainant jointly and severally on account of mental tension, agony and harassment suffered by the complainant due to the ill health of his _____.
ii) It is further prayed that the respondents may also kindly be directed to pay _____/- as charges of treatment spent by the complainant on the treatment of his _____.
iii) Costs of this petition may kindly be awarded in favour of the complainant and against the respondents.
iv) Any other relief, which this Hon’ble Forum may deem fit and proper, be passed in favour of the complainant and against the respondents.
Format of Affidavit for Consumer Case for Vehicle Insurance Claim
Format of Affidavit for Consumer Case for Vehicle Insurance Claim
BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, _____, _____
Complaint No._____ of _____ Under Consumer Protection Act
_____ …..Complainant
Versus
_____ …..Respondents
Complaint under section _____ of the consumer Protection Act, _____
EVIDENCE BY WAY OF AFFIDAVIT OF THE COMPLAINANT
I, _____ son of _____ resident _____ at present Resident of _____ do hereby solemnly affirm and declare as under:-
1- That the deponent is the consumer of the respondent as defined under the consumer protection Act, _____.
2- That the deponent is the registered owner of the vehicle _____ bearing its Registration No. _____ Engine No. _____, Chassis No. _____, Model _____. The said vehicle was get insured by the deponent with the respondent insurance company vide insurance policy No. _____ which was valid with effect from _____ to midnight of _____ covering all type of risks therein. As per the insurance policy issued by the respondent to the deponent , the said vehicle was get insured for the amount of _____/- (_____) . A photocopy of the insurance policy and a photocopy of Registration Copy of _____ No. _____ are exhibited herewith as _____.
3- That at the time of issuance of the above said insurance policy, the respondent had assured the deponent that the respondent would pass insurance claimed and make the payment of the claimed amount immediately, if the said vehicle will meet with accident or will be stolen at any point of time with in the validity period of the said insurance policy .
4- That in the mid night of _____ at about _____. The deponent parked his above said _____ in front of _____ in _____, but the said vehicle was stolen by someone in the night of _____. The deponent searched the said vehicle everywhere, but the where about of the said vehicle were not traced by the deponent. Hence the deponent got registered the FIR in the police station _____ bearing its FIR No. _____, dated _____ U/S. _____IPC regarding the theft of the said _____ against unknown thief. The copy of the FIR is exhibited herewith as _____.
5- That just after the steeling of the said vehicle of the deponent intimated the respondent and also submitted the FIR and all the relevant documents to the respondent regarding the steeling of the said vehicle.
6- That then after the deponent approached the respondent and requested to make the payment of the insured amount by raising the insurance claim in the office of the respondent. In this regard the respondent had issued the claim no. _____ and the respondent demanded the copy of the untraced report or final report from the deponent on _____.
7- That upon the application of the deponent the Hon’ble court of _____, has declared the above-mentioned vehicle as untraced vide its order dated _____. The copy of the order dated _____ is exhibited herewith as _____.
8- That then after the deponent personally visited the office of the respondent and met with the respondent and again approaching for claim in writing and submitted the final report along with the copy of the untraced report, photocopy of insurance policy , copy of the FIR, NCR Report, and copy of the R.C. of the said vehicle vide application dated _____.
9- That the respondent being the insurer of the above mentioned vehicle of the deponent and the above said vehicle has been stolen in the validity period of insurance policy, hence the respondent is liable and duty bound to pay the insurance claim as per the terms and conditions of the said policy to the deponent as soon as, but the respondent is trying to escape from their responsibility and liability to make the payment of the claimed amount to the deponent in arbitrary manner, hence the deponent is legally entitled to recover the amount of insurance claim along with interest from the respondent as per the terms and conditions of the insurance policy .
10- That the cause of action to file the present complaint accrued on each and every date when the deponent requested the respondent to make the payment of the insurance claimed amount and the cause of action finally accrued on _____ when the respondent has finally refused to make the payment of the insurance claimed amount to the deponent.
11- That the relevant documents which are produced before this Hon’ble Forum may kindly be read in my evidence.
Verification:-
Deponent
Verified that the above contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein
Verified at _____ on _____
BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, _____
_____ son of _____, resident of _____.
COMPLAINANT
VERSUS
1- _____ son of _____, resident of _____.
2- _____, _____ through its _____.
…..RESPONDENTS
Complaint Under Section _____ of the Consumer Protection Act _____ Amended up to date
Sir,
The complainant respectfully submits as under: –
1- That the complainant purchased _____ drinks marked as _____ on _____ from the shop of the respondent No.1 and out of the said _____ bottles one bottle was drinked by the _____ of the complainant
2- That the respondent No.1 is the retailer /seller of the products of the respondent No.2 and the complainant purchased _____ bottles _____. Each from the respondent No.1 so both the respondents being the seller and manufacturer of the _____ Drinks respectively. Thus the complainant is the consumer of both the respondents as defined under the various relevant provisions of the consumer Protection Act.
3- That the _____ of the complainant after _____.
4- That the complainant sent a legal notice dated _____ to the respondent No.1 calling upon him to release the bills regarding the purchase of bottle and the respondent No.1 gave the said Bill that was as Bill No. _____ dated _____ in favour of the respondent No.1, by _____ Drinks. (Copy of the same is enclosed herewith the complaint).
5- That due to the deficient and wrong service of the respondents the health of the complainant’s _____ was effected and the complainant was mentally and monetarily shocked. The complainant is entitled to receive _____/- as treatment charges of his _____from both the respondents jointly and severally
6- That the complainant is residing at _____ and the Respondent No.1 is doing his business at _____ and the respondent No. 2 is supplying the drinks at _____ at the shop of the respondent No.1 within the territorial jurisdiction of this Hon’ble Forum, therefore, this Hon’ble Forum has got the jurisdiction to entertain and try the present complaint.
PRAYER:
It is, therefore, prayed that in view of the forgoing facts and circumstances this hon’ble court may kindly be pleased to:
i) Pass an order directing the respondents to pay _____/- to the complainant jointly and severally on account of mental tension, agony and harassment suffered by the complainant due to the ill health of his _____.
ii) It is further prayed that the respondents may also kindly be directed to pay _____/- as charges of treatment spent by the complainant on the treatment of his _____.
iii) Costs of this petition may kindly be awarded in favour of the complainant and against the respondents.
iv) Any other relief, which this Hon’ble Forum may deem fit and proper, be passed in favour of the complainant and against the respondents.
Format of Affidavit With The Application For The Issue Of Duplicate Export Licence
Before the Deputy Chief Controller of Exports, Department of Supply, Ministry of Food, ………………………
In the matter of issue of duplicate licence to M/s. ………………………. Affidavit of A, aged about …………………… years, son of Shri …….. resident of ……………….. do hereby solemnly affirm and state as follows:
1 .That I am the proprietor of M/s. ………………….. doing the business of export and import of various items at ………………………..
2. That M/s. …………………… was issued license bearing No. ………. dated …………………….. for the export of …………………….. tons of ……………………………….
3. That the said licence has been lost, for which 1 lodged F.I.R. with Police Station, ……. …………….. vide F.I.R. No. ……………… dated ………………, a copy whereof is attached.
4. That the said licence has been lost without it being fully utilised and the ………………. so far exported on the said licence is to the extent of ……………. tons.
5. In the view of the above, it is requested that the duplicate copy of the said
licence may be issued. If the original licence be found any time, the same shall be returned to the issuing authority for cancellation, with being utilised.
I, A, the abovenamed deponent do hereby declare and verify that the contents of paras 1 to 4 foregoing are true to my knowledge and contents of paragraph 5 are submission to this Hon’ble Dy. Chief controller of exports, nothing material has been concealed and no part of it is false.
Verified at ………………….. on this …….. day of …………….. 201*.
Deponent
Date …………….
I, Smt. _________ widow of Late _________, resident of _________ , do hereby solemnly affirm and declare as under:-
1- That I am legally wedded wife of the above named deceased pensioner I have not remarried since the demise of my late husband.
2- That I am not in the receipt of any other family pension from any other source.
3- That my correct date of birth / age is _________ years.
4- That I am fully entitled to get the Widow pension from the _________.
Deponent
VERIFICATION
Verified that the contents of my above affidavit are true and correct to best of my knowledge and belief and nothing has been concealed therein.
I, _________ Son of _________ resident of _________ a _________ of _________ do hereby solemnly affirm and declare as under:
1. That my Child/Children Namely (I) _________ Son/Daughter was born on _________
(II) _________Son/daughter was born on _________
2. That above named son & Daughter is/are unemployed and is/are fully dependent on me.
3. That above named son& daughter is/are unmarried as on date.
4. That in case he/she starts earning or gets married, whichever takes place earlier, I will inform the _________ for discontinuance of the medical facility provided to him.
DEPONENT
VERIFICATION: –
Verified at _________ on this _________, _________ that the contents of above affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed there from.
I, ___________ wife of late __________ Resident of ________, Tehsil & Distt_________, do hereby solemnly affirm and declare as under:-
1. That Late __________is my husband who expired on dated ________ (Death certificate enclosed).
2. That he had the following account with __________ Bank, _____________vide
3. That he left behind the following legal heirs :-
(1) _________(2) ________(3) ___________(4) ________all sons/daughters of late ____________son of _________ & (5) ___________ Wife of late _________________ All resident of___________, Tehsil & Distt._______________,
4. That the deceased have no children of my aforesaid expect the mentioned above
DEPONENT
VERIFICATION:-
Verified that the contents of the above said affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
Verified at ___________ on this ____________
I, _________ S/o, D/o, C/o, Mr./Mrs _________ having been admitted to having been admitted to _________, have received a copy of the _________ Regulations on _________, Carefully read and fully understood the provision contained in the said regulations.