Affidavit Form

Full Name:

Address:

Birth Year:

Signature



Affidavit for Non-Availability of Mandatory/Prescribed Documents

I, , aged , residing at OR We ____________________________, a company incorporated under the provisions of Companies Act, 1956/2013 OR ___________________ and having its registered office at __________________________ (hereinafter called and referred to as “I” / “We”) do hereby solemnly affirm, state and declare as under:

WHEREAS, I am appointed by (i) Reliance Jio Infocomm Ltd. (RJIL), or (ii) by RJIL’s master distributor Reliance Retail Limited (RRL), or (iii) RJIL‘s or RRL’s authorised distributor, (each independently referred to as “Company”) pursuant to the agreement entered into with such Company, as a Retailer / Activation Partner / Point of Sale (hereinafter referred to as “Retailer”).

AND WHEREAS in furtherance of my obligations under the agreement with Company, I hereby state that on the date of my appointment as Retailer by the Company, the following documents were either not applicable and were not available.

AND WHEREAS I hereby undertake and agree to submit the following documents as and when they become applicable and available with me.

AND WHEREAS I, in order to record the above understanding, has agreed to undertake and declare as under.

DO HEREBY SOLEMNLY AFFIRM, SAY AND UNDERTAKE THAT:

1. I hereby state and confirm unavailability as of the date of this affidavit, of any or all of the below specified documents;

a. Corporate Identification Number / Limited Liability Partnership Identification Number (LLPIN) or Business License, or trade/ Registration number, or Incorporation Certificate or Certificate issued by authorities

b. Permanent Account Number (PAN)

c. Goods & Service Tax (GST) Registration Certificate

2. I am aware that the above documents, when applicable to my entity, are necessary to be provided to the Company, for the purpose of continue to act as Retailer of the Company for sale/distribution of product/services to the end consumers.

3. I understand the significance of the requested documents for the aforementioned purpose, and I am aware of the legal consequences of providing false information in this affidavit. I am presently unable to provide the requested documents, however, and I assure and undertake to diligently work towards obtaining and providing these documents as soon as they become applicable and available and are in my possession.

4. I am fully aware of the importance of this affidavit and the possible consequences of not fulfilling it.

5. I hereby declare that the information provided in this affidavit is true and accurate to the best of my knowledge and belief.

6. This affidavit shall at all times be read in consonance with the agreement. In the event of any conflict between the affidavit and the agreement, the provisions of this affidavit shall prevail to the extent of such conflict.

7. This affidavit shall be binding on me, my successors, legal representatives, assigns, agents, etc.



Solemnly affirmed at UNA on this date






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