WATER / SEWER CONNECTION AFFIDAVIT
Executed at __________ on __________.
I, __________, __________, resident of __________, holding __________, in respect of property within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:
- THE PROPERTY AND THE AUTHORITY
1.1 This affidavit is filed before __________ in support of __________ for water supply and sewerage at __________, identified as: __________.
- MY RIGHT TO OCCUPY
2.1 __________
- NO DUPLICATE CONNECTION
3.1 No other water or sewerage connection exists, or is being separately applied for, in respect of the same property, except the one referred to in this affidavit, and I have not obtained and am not seeking more than one connection for the same premises to defeat the authority's tariff or metering rules.
- DUES
4.1 __________
4.2 I undertake to clear any dues found outstanding against the property up to the date of this affidavit, and I indemnify __________ against any claim, loss or demand arising from a due, a defect in my title or right to occupy, or a statement in this affidavit that later proves incorrect.
- DECLARATION
5.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this application. I am aware that furnishing false information to obtain or continue a water or sewerage connection is an offence, and that __________ may refuse, disconnect or cancel the connection if any statement made here is found false.
VERIFICATION
Verified at __________ on __________ that the contents of paragraphs 1 to 5 above are true and correct to my own knowledge, that no part of it is false, and that nothing material has been concealed.
DEPONENT
Signature: ______________________________
__________
ATTESTATION
Solemnly affirmed and signed before me on __________ at __________, the Deponent having been identified to my satisfaction by __________.
Notary Public / Oath Commissioner
Registration No. and seal: ____________________