Sample Undertaking/Affidavit

I/we………….....R/o…………….Teh………..District……………..do

hereby solemnly affirm and declared as under:

1. That I/we have business establishment located at…………………..

Teh………….. District…………….. Pin Code ……………..

2. That I/we are applying for Packing Registration as required under Legal

Metrology (Packaged Commodities) Rules, 2011 for packing following

Product(s)/Items 1)

___________2)_________3)_________4…………etc..

3. That the Name of the firm under the Brand Name with

my/our Location/Address at

……………………………………..is ……………………………………

4. That I/we shall pack Products/Items in accordance with the applicable

provisions /rules of Legal Metrology Act, 2009/ LM (Packaged

Commodities) Rules, 2011 as specified or amended from time to time as

may be applicable.

5. That I shall abide by all the rules and regulations of the Legal Metrology

Department as amended from time to time.

6. That I shall abide the instructions and orders issued by the Legal

Metrology Department.

7. That I/we know that legal action can be taken against me/us/our firm, if,

any, violation of law or rules of the Department is made by me/us/our

firm.

Deponent

Verification:

I/ we further do hereby declare that all the statements made by me/us are true to

the best of my/our knowledge and belief and nothing has been concealed and

further state that I/ we shall fully comply with the all the provisions of the Legal

Metrology Act, 2009 and the rules made thereunder as may be applicable.

Deponent

( Signature of the applicant )

(with official seal…………..)

Place:

Dated:

Identified by:

1………………………………….

2………………………………….

(To be attested by Ex. Magistrate Ist class/ Notary)