I, _________ Son/Daughter of _________ resident of _________, Authorized Signatory/proprietor/partner/ Director of M/s. _________ situated at _________ do hereby solemnly declare as under:-
1. That I have applied for the renewal of license/grant of registration under Ad hoc registration scheme-_________ for running the trade/unit of _________ of _________.
2. That I had started the trade / unit above promises w.e.f. __________________.
3. That the said trade/ unit is not pollutant/noxious/ hazards/inflammable.
4. That I have submitted the following documents as proof of running the above said shop/trade/commercial unit:-
1) Undertaking Affidavit
2) NOC From Owner
3) Lease deed/ Rent Agreement etc.
4) Memorandum, Articles of Association
5) Resolution (Authorized Signatory)
6) Registration charges /Conversion Charges receipt.
7) Site Plan & Key Plan etc.
5. That I am in occupation of the said premises as owner/tenant w.e.f. ____________.
6. That I have/do not have an electric connection in my name.
7. That the _________ shall be empowered to revoke my registration/license, if any unauthorized construction is noticed in the aforesaid premises. The _________ authorities shall be competent to demolish the unauthorized construction and I shall not claim any compensation on that account.
8. That I/we will not claim any alternative site in any confirming area in lieu of the of the ad hoc registration/ license granted to me/us for the above said trade/unit run by me us in the non-confirming area details whereof have been mentioned here in above.
9. That nothing has been concealed in this connection and I/we shall be responsible for all the consequences in case the above contents are found incorrect and registration may be cancelled at my/ our own risk.
10. That I shall not claim regularization construction in respect of the premises in which the above said trade/ commercial activity in being run by me/ us on the basis of such ad hoc license/ registration.
11. That I have neither changed the trade/commercial activity for which the adhoc license was issued to me/ us in the year _________ nor have I/we added any new trade/ commercial unit after the grant of ad hoc license/ registration.
VERIFICATION:-
Verified at _________ on this _________ Month, _________ (Year) that contents of the above affidavit are true and correct to the best of my knowledge and belief and nothing is false or has been concealed there from.