Affidavit Form

Full Name:

Address:

Birth Year:

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/ We are 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 Franchisee / Agent / Distributor / Retailer / Activation Partner / Point of Sale (hereinafter referred to as "PoS / Retailer").

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

AND WHEREAS I/We hereby undertake and agree to submit the following documents as per paragraph 1 below, as and when they become applicable and available with me.

AND WHEREAS I/We, 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/We hereby state and confirm unavailability of any or all of the below mentioned documents at the time of signing of the POS Agreement / T&Cs and also as of the date of this affidavit;

a. Corporate Identification Number (CIN) / 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/ We are aware that the above documents, when applicable to my entity, are necessary to be provided to the Company, for the purpose of to continue to act as PoS / Retailer of the Company for sale/distribution of product/ services to the end consumers.

3. I/We understand the significance of the requested documents for the aforementioned purpose, and I am /We are aware of the legal consequences of providing false information in this affidavit. I am /We are presently unable to provide the requested documents, however, and I /We 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 /We are fully aware of the importance of this affidavit and the possible consequences of not fulfilling it.

5. I/We hereby ratify, affirm, and confirm all statements, declarations, undertakings, representations, and acts referred to herein, and declare that the same are 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/ us, my/ our successor, legal representatives, assigns, agents, etc. and who so ever derives the title through me/us.



Solemnly affirmed at UNA on this date



___________________________________________
(Retailer)


In the Presence of