Annexure A1 (Affidavit to be submitted by individuals and partners of partnerships) I, son/daughter/wife of Age years residing at do hereby solemnly affirm and say as under: That I am an Indian National. 1 That I am unmarried. That I am married. OR 2 That I have never been convicted of any criminal offence by any Court of Law. 3 That I hereby confirm that I was never a signatory to dealership/distributorship agreement of any oil company, which was terminated. 4 @ That against item no. of my application form details of various sources of funds required for setting up and operation of the ESPS/SSP (strike out whichever is not applicable) has been furnished. I under take that these funds will be made available for the purpose of setting up and operation of ESPS/SSP (strike out whichever is not applicable). In case it is found that the same is not made available as and when required, the offer of ESPS/SSP (strike out whichever is not applicable), at any stage, can be withdrawn and that I will have no claim/damages whatsoever against Hindustan Petroleum Corporation Limited. 5 That if any information/declaration given by me in my/our application or in any document submitted by me/us in support of application for the award of the ESPS/SSP(strike out whichever is not applicable) or in this affidavit shall be found to be untrue or incorrect or false, Hindustan Petroleum Corporation would be within its rights to withdraw the letter of intent / terminate the ESPS/SSP distributorship (if already appointed) and that I would have no claim, whatsoever, against the Corporation for such withdrawal / termination, however the Corporation shall be at liberty to recover necessary damages/costs against the same. I hereby verify that what has been stated above is true to the best of my knowledge and correct. and nothing material has been concealed therefrom. Signature and Seal of Magistrate/Judge/Notary public Signature of person making affidavit
Annexure: A2-LLP A3-Company/Registered Society (To be submitted by Registered Co-operative Societies and Organized bodies like Government Organizations / Corporations / Undertakings, Public LTD. Companies, and Companies incorporated under Companies Act or LLP incorporated under LLP Act) I, son / daughter / wife of Age years resident of in the capacity of do hereby solemnly declare : 1 That through a resolution passed by the Co-operative society*/corporate Houses*/LLP (strike out whichever is not applicable), I have been authorized to apply for the said E S P S / S S P (strike out whichever is not applicable) distributorship. A copy of the resolution/authorization is enclosed herewith forming part and parcel of this affidavit. 2 That the said Registered Society is duly registered under society Registration Act 1860 */Company formed under the companies act 1956*/LLP is duly registered under Limited Liability Partnership Act, 2008 on (date of registration/incorporation) and a photocopy of the certificate of registration certificate is enclosed herewith forming part and parcel of this affidavit. 2 That our Registered society / Company/LLP (strike out whichever is not applicable) had made profit during the previous 3 consecutive financial Years as certified by Chartered Accountant. 4 That on behalf of the Co-operative Society*/Company/LLP (strike out whichever is not applicable), I undertake that we will observe all the relevant guidelines with regard to award/operation of the said ESPS/SSP (strike out whichever is not applicable) distributorship issued by Hindustan Petroleum Corporation*/Government of India or any other statutory body from time to time. 5 That our Registered Society */Company*/LLP *(strike out whichever is not applicable) does not have any criminal records nor was its Governing Body/Managing Body /Any such other Body of the Registered Society */Directors of company /Partners * were convicted for any criminal offence by any court of law punishable under law. 6 That our Registered Society */Company*/LLP *(strike out whichever is not applicable) nor its members/directors/partners were never a signatory to dealership/distributorship agreement of any oil company, which was terminated. 7 That If any information/declaration given by me in my/our application or in any document submitted in support of application for the award of the ESPS/SSP (strike out whichever is not applicable) distributorship or in this affidavit shall be found to be untrue or incorrect or false, Hindustan Petroleum Corporation Ltd would be within its rights to withdraw the letter of intent / terminate the ESPS/SSP (strike out whichever is not applicable) distributorship (if already appointed) and that we would have no claim, whatsoever, against Hindustan Petroleum Corporation for such withdrawal/termination, however the Corporation shall be at liberty to recover necessary damages/costs against the same. I hereby verify that what has been stated above is true to the best of my knowledge and correct. and nothing material has been concealed therefrom. Signature and Seal of Magistrate/Judge/Notary public Signature of person making affidavit
Annexure -A4 (To be submitted by all applicants: Credit worthiness certificate from the Bankers, from a Scheduled bank / Financial institution to be obtained in their Letter Head in the following format and enclosed with the application) TO WHOMSOEVER IT MAY CONCERN Shri / Smt / Kum / M/s- is a customer of this bank for last. Years and he / she / they is / are enjoying the following facilities from our bank / institution: a) b) c) During the above period, the dealings of Shri / Smt / Kum / M/s- with the bank and his / her / their conduct has been satisfactory. In case, a distributorship is allotted to him / her /them, we will be willing to extend a loan of Rs Signature Name and Designation Office seal Date
Annexure A5 (To be given by the family member as defined in eligibility criteria other than applicant) I Son/wife of Age years resident of do hereby solemnly affirm and say as under: - 1 That I am unmarried and my father*/mother*/ brother* / sister/ * (Mr/Ms) (name) has applied for ESPS/SSP* distributorship of HPCL at _(location) under ' ' category against the advertisement made in newspaper/website* dated OR That I am married my son*/ daughter*/wife*/husband*/father*/mother*/ father in law*/ mother in law*/brother in law*/sister in law* (Mr/Ms) ( name) has applied for ESPS/SSP* distributorship of HPCL at _(location) under ' ' category against the advertisement made in newspaper/website dated * Strike off whichever is not applicable. 2 That in case he/she is selected for ESPS/SSP* distributorship I will provide financial assistance to the extent of Rs which is mentioned at Item no. under my name in the application submitted by (Mr/Ms. for ESPS/SSP* distributorship of HPCL at (location) 3 That in case he/she is selected as an ESPS, I have no objection for construction of godown / showroom on the land specified in item no.. (Not applicable for SSP)* I hereby verify that what has been stated above is true and correct to the best of my knowledge, and nothing has been concealed therefrom Signature and Seal of Magistrate/Judge/Notary public Signature of persons making affidavit