A F F I D A V I
T
(On non-judicial
stamp paper of minimum Rs.5/=)
I ______________________________ S/O
________________________aged
_________ years and resident of ________________________________ do hereby
solemnly affirm and state :
1. that I am the sole Proprietor/
Partner/Director of the firm namely
___________________________________________
situated
at_______________________________________.
2.
that the grade designation mark in accordance with the provision of the
A.P(G&M) Act, 1937 and the rules made thereunder, will be applied at_________________ ________________ (address
of the premises).
3. that
the proposed premises which is situated at __________________________________is
owned by me/our firm/not owned by me/our firm.
4.* that the proposed premises which is situated at________________has been taken on rent/ lease from _________________(name of
owner) who is the legal owner of the
said premises.
5.
that the trade brand label(s)
_______________ belong to me/our firm
which is/are registered/not registered
with the Registrar of trade marks.
6.
that the trade brand label(s) ________________ shall be used only on
Agmark graded products.
7.
that the packing material used for packing graded products under Agmark
is of "Food Grade" .
(Signature of the deponent)
Place:
Date:
V E R I F I C A
T I O N
I _____________________________
solemnly state and verify that the contents of the above affidavit are true and
correct.
(Signature of deponent)
Attested
by NOTARY
* Delete, if not applicable.