AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra

(clpunang032), Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 28/10/2013

NAME OF TRANSFER AFFIDAVIT

From :- Akshay Lajaras Upar

Swati Lajaras Upar,

Resident of At-Post Manchar Tal-Ambegaon ,Dist-Pune .410503
To,
The Chief Rgional Manager,
Bharat Petrolium Corporation Limited,
I,4&6 CURRIMBHOY RODE P. OBPX NO 688 BALLARD ESTATE MUMBAI -400001

Dear Sir,
This is to advise you that Swati Lajaras Upar who was residing At Post
Manchar,Tal-Ambegaon,Dist-Pune has left with we your equipment covered under your
subscription Voucher No. 3018491638 Date 12/060/2010 since Swati Lajaras Upar does not
intend making use for the said equipment, I request that the same may be transferred with the
name and a freash Consumer No 1463 Consumers copy of the SV No. --------------------------
dated issued to Akshay Lajaras Upar is surrendered here with. I confirm that I
am agreeable to pay to the corporation the deposit for the equipment as per your terms
currently in force. I give below the consent from Akshay Lajaras Upar Requesting Bharat
Petrolium Corporation Limited, to transfer his/her consumer ship in name and also
authorizing we to sing the T.V. and accept refund of deposit amount on his her behalf.

Date : Signature
Swati Lajaras Upar

Swati Lajaras Upar hereby confirm that I have no objection to the corporation transferring
the subject gas connection covered by SV ----------------------------- held by to Akshay Lajaras
Uparand hereby explicitly authorize Bharat Petrolium Corporation Limited, To do so and
permit his/her to sing T.V. as well as accept the refund of deposit on my behalf I hereby totally
surrender my claim for this gas connection and shall not have any claim whatsoever at any
future date

All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199, 193(2), 200 under I.P.C.

Signature
Akshay Lajaras Upar
 AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra

(clpunang032), Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 22/04/2013

I Adityakumar Bhagat
Permanent Address – Charri Swail Nirankari Niwas,
Shanti Chowk, NR RLY Station Udhampur, P.O. Udhampur – 182101,(J
& K)
Address- Government College of Engineering and Research (Awasari) Boys Hostel, Block A,
Awasari Khu., Tal.- Ambegaon, Dist.-Pune Pin No. 412405
Age - 18 years

Do hereby solemnly affirm & declare on oath as follows:-

I have taken admission at Government College of Engineering and Research (Avasari
Khurd), Dist.-Pune, Maharashtra State in the year 2012-13 for 1st year Automobile
Engineering and I have applied only for Special JK scholarship and not applied for any other
Government scholar ship.

I, the above mentioned deponent do hereby solemnly affirm and declare that the
contents of the above said affidavit are true to the best of my knowledge and belief and nothing
has been concealed therein

I No. 15581561FSPR Chavan Pravin Subhash aged 24 Yrs son of shri Subhash Unit 106 Eng
Regiment APO do hereby solemnly affirm and declare on oath as under :-

1.That I have lost my canteen Grocerry Card

At Manchar on dated dec., 2012 It was Kept in my pocket/bag which slipped away from
my pocket/bag
2.That above said Card is not traceable inspite of my sincere and best efforts. Hence this
affidavit for registration of FIR in this behalf

AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 30/11/2012

Txn No.

I Changuna
Address- At Shevalwadi Post Manchar, Tal.- Ambegaon, Dist.-Pune
Age - 66 years,
 Changuna And Changunabai Natha Dere are he Names of one person and I am known
by both the name

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this on 30/11/2012.

All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199, 193(2), 200 under I.P.C.

Signature
Changunabai Natha Dere
\

No. MAG/SR/CSC /Manchar /2012

Date 29/10/2012
Solemany affirmed before me by
Shri/ Smt - Ganpat Kondaji Bangar
Address- Pimpalgaon, Tal.- Ambegaon, Dist.-
Pune
Taluka Executive Magistrate/Circle Officer
CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 22/08/2012

Txn No.

Undertaking regarding EBC for the academic year 2012-13

I Mr. Bankhele Akshay Satishkumar studying in FE/SE/TE/BE branch Chemical Roll No.
________ for the academic year 2012-13.
 I hereby undertake that, my admission is through CAP round I/II/III counseling round
under open category and if my application is rejected by Government authorities for any
reason, I will be wholly responsible to settle such observation.

1) I have not applied for any scholarship/ freeship/Minority/ AICTE fees waiver scheme/
Grant/ Inst fee waiver scheme/ stipend or any such benefit from any other
organization / Institute etc. for the academic year 2012-13.
2) I am not receipt of any scholarship/ freeship/Minority/ AICTE fees waiver scheme/
Grant/ Inst fee waiver scheme/ stipend or any such benefit from any other
organization / Institute etc.

Parents Income Rs. 32,000/- of Tahsil Place Ambegaon. Latest Result Pass/Fail//ATKT

Apatya Kramank 1st /2nd/ 3rd

_______2nd ________

Signature of Father/ Mother Signature of

Student
Mobile No. ___________ Mobile No. ___________

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199, 193(2), 200 under I.P.C.
Solemnly affirmed and declared before me this on 23/08/2012.

Signature _________ Signature

Deponent/identified by Pramila Satishkumar Bankhele

No. MAG/SR/CSC /Manchar /2012

Date 23/08/2012
Solemany affirmed before me by
Shri/ Smt - Pramila Satishkumar Bankhele
A/P- Manchar, Tal.-Ambegaon, Dist.-Pune
Taluka Executive Magistrate/Circle Officer

CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

I Vasant Shankar Ghisre
Age - 63 years, Occupation – Business
Resident of A/P- Nigadi, Tal.-Haveli, Dist.-Pune

Do hereby solemnly affirm & declare on oath as follows:-

Statement declared in stamp paper no. 1134 dated 22/8/2012 (FY 892336) is correct
and true.

AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 24/5/2012

Txn No.

I shri. Yogesh Machhindra Bhand son of Shri Machhindra Haribhau

Bhand and (Smt) Nanda born at Paithan of Hindu cast of Dhangar (sub caste )
belonging to Hindu (religing), presently residing at village Jarkarwadi Post
Office Pargaon Taluka Ambegaon of Pune District, in the state of Maharashtra
solemnly declare and affirm that :-

(a) I have not been a member of a banned / political organization.

(b) I have never been in custody or Jail / no Criminal of Judicial case is
pending against me in India or abroad.
 (c) I have not been convicted for any offence under the law.

(Signature/left thump impression of Prospective recruit )

Sworn / Affirmed in my presence / in front of me

Place : Manchar Yogesh Machhindra Bhand

Date : 24/05/2012
No. MAG/SR/CSC /Manchar /2012
Date 24/5/2012
Solemany affirmed before me by
Shri/ Smt - Yogesh Machhindra Bhand
At-Jarkarwadi Post – Pargaon, Ambegaon,
Pune
Taluka Executive Magistrate/Circle Officer

(Date of seal of the executive magistrate)

 AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 28/08/2012

Txn No.

I Bhagyashree Raghunath Dhimdhime

Age - 19 years, Occupation – Studant
Resident of Sinhgad Rd. Shahu Nagar, Pune

Do hereby solemnly affirm & declare on oath as follows:-

Statement declared in stamp paper no. 2256 dated 24/08/2012 (FY 893234) is correct
and true.

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this on 28/8/2012.

All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199, 193(2), 200 under I.P.C.

Signature _________ Signature

Deponent/identified by Bhagyashree Raghunath Dhimdhime

No. MAG/SR/CSC /Manchar /2012

Date 28/08/2012
Solemany affirmed before me by
Shri/ Smt -Bhagyashree Raghunath Dhimdhime
At/Post – Sinhgad Rd. Shahu Nagar, Pune
Taluka Executive Magistrate/Circle Officer

CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

1. I carrying on business at At/Post- Manchar, Tal.-Ambegaon, Dist.-Pune under the style
of M/S Uttambhagya Jwellers and applied for the licence under BIS Certification
Scheme for Hallmarking of Gold Jewellery / Artefacts as per IS 1417:1999 hereby
undertake that,

a) I/ We will intimate BIS whenever there is any changes of name, address or management
of the firm.

b) I/ We will be fully responsible to the declared fineness of hallmarked jewellery/artefacts

manufactured/ retailed by us.

c) I / we will use cadmium free solders only, while manufacturing Gold Jewellery/
Artefacts meant for Hallmarking purpose.

d) The Jewellery/Artefacts manufactured shall be free from the various elements as

prohibited in IS 1417 (with all the amendments as in force from time to time).

e) I / We will not use “KDM” Making on the Gold Jewellery /Artefacts meant for
Hallmarking.

f) That for artefacts (Medallions) the designs likely to resemble currency of any country
shall not be submitted for hallmarking and only approved designs shall be submitted
for hallmarking.

g) I/We will take the responsibility for the complaint redressal in respect of any complaint
received, as per BIS scheme for certification of gold jeweler/ artefacts for fineness
marking.

h) That the cash memo issued by us to the customer shall indicate fineness along with
corresponding caratage in addition to other legally mandatory details.

i) To strictly follow the display requirements as per BIS scheme for certification of gold
jewellery /artefacts for fineness marking.
 j) I/ We shall supply free of charge the sample or samples required in accordance with the
Bureau of Indian Standard (Hallmarking of Precious Metal Articles ) Regulations from
his premises, factory or showroom.

k) I/We will use or Identification mark as given below on the entire Jewellery/ Artefacts
sent for Hallmarking.

UBJ

2. We understand that non fulfillment of any of the above conditions or as laid down in
BIS Scheme for certification of gold jewellery / artefacts for fineness marking may
result in cancellation of the BIS license.

3. On expiry of the validity of license, we have the responsibility of applying for renewal of
licence through renewal application form.

Statement declared in stamp paper no.13441 (EU 096531) & 13442 (EU 096530) is
correct and true.

AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 29/12/2011

Txn No.

We 1- Mr. Pravin Shashikant Kadadhekar, Age -34 years, Occupation _ Doctor

2- Mrs. Shilpa Pravin Kadadhekar, Age -34 years, Occupation _ Doctor
Resident of Manchar, Tal.- Ambegaon, Dist-Pune

Do hereby solemnly affirm & declare on oath as follows:-

 1) That the state bank of India, A Bank established under state bank of India act 1955
having its branch at Manchar has at my request agreed to grant housing loan facility to
me .For that purpose I have to produce “No Dues” certificate from individual financing
institution /Bank & hence this affidavit is being sworn.

2) We have not obtain any loan, credit facility from any financial institution/ Bank and / or
We are not defaulter to any financial institution/ Bank and no legal action is initiated
against us or recovery for of loans or for the reasons/ purpose.

a) We have obtained Housing Loan of Rs. 13,00,000/- from Bank of Maharashtra,

Manchar Br., and 6,00,000/- from Sainath Patsanstha, Manchar.

3) That the undertaking & declare further to notify to the state Bank of India Manchar
branch the changes .That the statement /declaration made in this affidavit in para (1)
and (2) are true to the best of my knowledge.

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this 29/12/2011

All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199,193(2), 200 under I.P.C.

Signature _________ Signature Signature

Deponent/identified by Deponent Deponent

No. MAG/SR/CSC /Manchar /2011

Date 29/12/2011
Solemany affirmed before me by
Shri/ Smt - Shilpa Pravin Kadadhekar &
Pravin Shashikant Kadadhekar
At/Post – Manchar , Ambegaon, Pune

Taluka Executive Magistrate/Circle Officer

CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

 The Statement declared I Stamp Paper 5874 dated 27/12/2011 ( EW 808254 ) is true and
correct.

4) That the state bank of India, A Bank established under state bank of India act 1955
having its branch at Manchar has at my request agreed to grant housing loan facility to
me .For that purpose I have to produce “No Dues” certificate from individual financing
institution /Bank & hence this affidavit is being sworn.

5) We have not obtain any loan, credit facility from any financial institution/ Bank and / or
We are not defaulter to any financial institution/ Bank and no legal action is initiated
against us or recovery for of loans or for the reasons/ purpose.

b) We have obtained Housing Loan of Rs. 31,50,000 from State Bank of India,
Manchar.

6) That the undertaking & declare further to notify to the state Bank of India Manchar
branch the changes .That the statement /declaration made in this affidavit in para (1)
and (2) are true to the best of my knowledge.

AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 24/12/2011

Txn No.

We 1. Mr. Harshad Ashok Shete, Age -37 years, Occupation _ Doctor

2. Mrs. Madhura Harshad Shete, Age -34 years, Occupation _ Doctor

Resident of Manchar, Tal.- Ambegaon, Dist-Pune

Do hereby solemnly affirm & declare on oath as follows:-

7) That the state bank of India, A Bank established under state bank of India act 1955
having its branch at Manchar has at my request agreed to grant housing loan facility to
me .For that purpose I have to produce “No Dues” certificate from individual financing
institution /Bank & hence this affidavit is being sworn.
 8) We have not obtain any loan, credit facility from any financial institution/ Bank and / or
We are not defaulter to any financial institution/ Bank and no legal action is initiated
against us or recovery for of loans or for the reasons/ purpose.

c) We have obtained Housing Loan of Rs. 31,50,000 from State Bank of India,
Manchar.

9) That the undertaking & declare further to notify to the state Bank of India Manchar
branch the changes .That the statement /declaration made in this affidavit in para (1)
and (2) are true to the best of my knowledge.

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this 23/12/2011

All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199,193(2), 200 under I.P.C.

Signature _________ Signature_ Signature

Deponent/identified by Deponent Deponent

No. MAG/SR/CSC /Manchar /2011

Date 23/12/2011
Solemany affirmed before me by
Shri/ Smt - Harshad Ashok Shete
At/Post – Manchar , Ambegaon, Pune

Taluka Executive Magistrate/Circle Officer

CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

AFFIDAVIT
 In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,
Manchar, Tal.-Ambegaon, Dist.-Pune

Affidavit No. Date - 23/12/2011

Txn No.

AFFIDAVIT CUM UNDERTAKING

I Dr. Saurabh Satish Gujrathi Son of Shri. Satish Chimanlal Gujrathi aged 31 years,
resident of Manchar, Dist.-Pune owner/Proprietor/ Institution Head of Genetic
Counseling Center / Genetic Laboratory / Genetic Clinic / ultrasound clinic/ Imaging
Centre / Combination thereof do hereby declare and state on solemn affirmation as
under.

I say that I undertake to abide by the provisions of the pre-conception and Pre
–Natal Diagnostic Techniques (Prohibition of Sex Selection) Act 2003 and the rules
made there under.

I further say and undertake that the Genetic Center/Genetic Laboratory/

Genetic Clinic/ Combination threrof as the case may be shall not conduct any test or
procedure, by the soever name called for selection of “Sex” before of after
conception or for detection of sex of foetus except for diseases specified in Section
4(2) nor shall the sex of foetus will be disclosed to anybody.

I also undertake to explain the said Act and Rules to all employees of the
Genetic Counseling Centre/ Genetic Clinic. Ultrasound clinic/ Imaging Centre in
respect of which registration is sought and to ensure that Act and Rules are fully
complies with
I also under take to display prominently at the Generic Center / Laboratory/
Clinic/ Combination thereof as the case may be a notice that we do not conduct any
technique, test or procedure etc. by whatever name called for detection of sex of
foetus or for selection of sex before or after conception.

This affidavit is made for submitting the same to the Appropriate Authority
along with all application for Renewal of Registration of Genetic Counseling Center/
Genetic Laboratory/ Genetic Clinic/ Ultrasound clinic / Imaging Center or
Combination thereof as the case may be.

All above information is true and correct to the best of my knowledge and
belief in this contest abide by provision of section 199,193(2), 200 under I.P.C.

Deponent

Saurabh Satish Gujrathi

No. MAG/SR/CSC /Manchar 8027 /2011

Date - 16/12/2011
Solemany affirmed before me by
CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

AFFIDAVIT

Tokan No. 3116 Date 21/4/2011

Txn No.
In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,
Manchar, Tal.-Ambegaon, Dist.-Pune

I /We Mr. Shinde Siddheshwar Khandu

Mr. Shinde Khandu Bhairavnath

Resident of Awasari Khurd, Tal.- Ambegaon, Dist-Pune

Do hereby solemanly as firm and declares as under,

1- The particulars furnished are to the best of mu/our knowledge true and correct.
2- The advance, if granted, will be utilized for the purpose for which it is granted.
3- I / We hereby authorize the bank to pay the fee and other amounts as may be payable
directly to the instution concerned.
4- I / We undertake to submit the receipt for all the disbursements made from the loan
account.
5- I/We undertake to inform the progress of studies of the student in a respect of education
for which loan is applied.
6- I/We shall keep the bank informed of my activities/ Income/Scholarship etc. during the
tenure of the loan.
7- I/We Imediatiy on securing job by the student. I /We undertake to inform the
employment details.
 8- I / We undertake to maintain a saving bank account and / of deposit account with your
bank exclusively.
9- I/We will not /have not borrow/ed from othe bank or any other source during the
currency of the advance without your prior consent in writing
10- I /We undertake to meet contingent expenses to continue the course of study.

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this 13th day of January 2010.
All above information is true and correct to the best of my knowledge and belief in this
contest abide by provision of section 199,193(2), 200 under I.P.C.

Date : Yours faithfully

Place :- STUDENT PARENT/GUARDIAN

I AM WILLING TO STAND AS GUARANTOR

Place
Date Signature of the guarantor/s

No. MAG/SR/CSC /Manchar /2010

Court Fee Date 13/1/2011
Stmp Solemany affirmed before me by
Shri/ Smt Siddheshwar Khandu Shinde
Khandu Bhairavnath Shinde

At/Post –Awasari Khu.,, Ambegaon, Pune

Taluka Executive Magistrate/Circle Officer

 AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. Date 28/12/2011

Txn No.

I Kishori Popatrao Shinde

Resident at Manchar, Tal.- Ambegaon, Dist-Pune
Age -50 years, Occupation - Service
Do hereby take oath and state on solemn affirmation as under –

(In case of non availability of marriage certificate or gazette copy)

1. I state that I was married to Late Popatrao Sahadu Shinde on 29/5/1981.

2. I state that our marriage took place at Pune.
3. I state that my husband Mr. Popatrao Sahadu Shinde expired on 1/9/2011 at Pune.
4. I state that till the date he was alive, I was his wife and after his death I am his
widow.
5. I state that my maiden name was Kishori Chandrakant Khaire which was changed
to Mrs. Kishori Popatrao Shinde after marriage.
6. I state that I have not remarried till date.
Whatever stated herein above is true and correct to the best of my knowledge and
belief and I have signed this affidavit on this 28 day of December, 2011

I hereby verify and confirm that what has been stated above is true to the best of
my knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this 28/12/2011

All above information is true and correct to the best of my knowledge and belief
in this contest abide by provision of section 199,193(2), 200 under I.P.C.

I know this person Deponent

Kishori Popatrao Shinde

No. MAG/SR/CSC /Manchar /2011

Date 28/12/2011
Solemany affirmed before me by
Shri/ Smt - Kishori Popatrao Shinde
At/Post –Manchar , Ambegaon, Pune

Taluka Executive Magistrate/Circle Officer

CSC ID -clpunang032/CSC Manchar/Rajani Sharadrao Shinde

solemanly as firm and declares as under,

DECLARATION OF FAMILY INCOME AND MINORITY STATUS

I Mrs. Trupti Sanjay Shah (Name of Mother) Age 39, Occuption –Business, Resident
of Manchar, Tal.- Ambegaon, Dist.-Pune Parent of Indrani Jitendra Shah (Name of
Student) who is studying in
 AFFIDAVIT

In The Court Of Executive Magistrate / Circle Officer, Maha-E-Seva Kendra,

Manchar, Tal.-Ambegaon, Dist.-Pune

Tokan No. 3409 Date 24/5/2011

Txn No.
I Mr. Vinaykumar Jalindar Kate
Resident of Manchar, Tal.- Ambegaon, Dist-Pune
Age 27 years, Occupation – Student

Do hereby solemnly affirm and declare as under,

That I have got admission into Indian Institute of Management, Ahmedabad for the
Academic Batch of 2011 -2013. For this education I am applying for Rajaishi Shahu Maharaj
Gunvatta Scholarship of Government of Maharashtra.

In case if I fail to complete the course for which I have been awarded scholarship, I
shall repay the complete amount to Government of Maharashtra.

I hereby verify and confirm that what has been stated above is true to the best of my
knowledge, correct and nothing material has been concealed there from.

Solemnly affirmed and declared before me this 21/4/2011

All above information is true and correct to the best of my knowledge and belief in this
contest abides by provision of section 199,193(2), 200 under I.P.C.

Deponent

Vinaykumar Jalindar Kate

No. MAG/SR/CSC /Manchar 3409 /2011

Date 24/5/2011
Solemany affirmed before me by
Shri/ Smt Vinaykumar Jalindar Kate
At/Post –Manchar, Ambegaon, Pune

Taluka Executive Magistrate/Circle Officer