ਆਪਣੀ ਜਾਣਕਾਰੀ ਭਰੋ

DUPLICATE RC OR INSURANCE AFFIDAVIT

I, __________, __________, aged about __________ years, resident of __________, holding __________, applying within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. 1. THE APPLICATION

1.2 I make this affidavit for filing before __________.

1. 2. THE VEHICLE

1. 3. CIRCUMSTANCES OF LOSS

1. 4. DECLARATION

4.1 Every statement made above is true to my own knowledge, information and belief, and I have concealed nothing material to this application. I am aware that furnishing false information in support of this application is an offence under the Motor Vehicles Act, 1988, or, as the case may be, is a false declaration to the insurer, and that the duplicate sought is liable to be refused, or cancelled, if any statement made here is found false.

VERIFICATION

DEPONENT

Signature: ______________________________
__________

ATTESTATION