INSTRUCTIONS FOR RECONSTITUTION OF COMMISSIONED DEALERSHIP

1. The Reconstitution Policy must be read and understood fully. The application complete
in all respects including processing fee must be submitted to the respective
Divisional/Territory/Regional Office of IOC/BPC/HPC, as applicable, preferably in
person. If sent by post/courier the same must be addressed to the respective
Divisional/Territory/Regional Office in-charge.

2. An acknowledgement of receipt of application will be issued by the

Divisional/Territory/Regional Office along with a reference number. In cases where the
applications are not handed over in person and if acknowledgement is not received
within 15 days, the same to be brought to the notice of the Divisional/Territory/Regional
Office in-charge immediately. For all future correspondence the reference number to be
mentioned.

3. Application processing fee : A non refundable application processing fee of Rs.25,000/-

for reconstitution, in the form of DD, in favour of Indian Oil Corporation Ltd. / Bharat
Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd., as applicable, and
payable at the Divisional/Territory/Regional Office location, will be payable along with the
application as per the Reconstitution policy, as applicable.

4. Reconstitution fee :Non refundable reconstitution fee equivalent to prevailing security

deposit (as applicable to Dealership Selection policy in vogue) will be collected before
execution of agreement as per the reconstitution Policy, as applicable.

5. In case of reconstitution proposals on account of incapacitation due to serious

illness/accident resulting in total and permanent disability which will disable the dealer
(proprietor / partner) to work or follow any profession, Chief Medical Officer of the Govt.
Hospital or Medical Board recognized by the Govt. need to certify the incapacitation for
considering the proposal.

6. If the nominee / legal heir / family member of the deceased/incapacitated

proprietor/partner(s) does not possess minimum education qualification in line with
dealer selection policy in vogue and is proposing to become the proprietor/partner, then
the Committee of Officers appointed by the Corporation will verify whether such legal
heir/s is/are able to read, write and count.

7. At an appointed date the existing/continuing proprietor/partner(s) along with the

proposed partners have to appear before the Committee along with the original
documents, copies of which were submitted/required along with the application.

8. All the pages of the application along with the annexures to be signed/self attested by all
the existing partner/s and incoming partner(s).

9. In case the nominee / legal heir / family member is a minor, then local guardian
proposing to operate the RO is required to sign alongwith the minor nominee / legal heir
/ family member wherever applicable.

10. After receiving the “in principle” approval for the reconstitution, the documentary
confirmation and legal compliance must be submitted to the Divisional/Territory/Regional
Office in-charge within 60 days.
 ANNEXURE-A2

APPLICATION FOR RE-CONSTITUTION OF COMMISSIONED DEALERSHIP

Date : ____________
S. PARTICULARS DETAILS
NO.
1 Details of Dealership
(a) Whether Dealership is on sole proprietorship Proprietorship
or partnership :
(b) Name of Dealership P.G. FILLINF STATION
(c) SAP Code 157638
(d) Date of Commissioning of Dealership : 2006
(e) Age of dealership as on date of proposal : 12
(f) Location : Tentigaon
(g) Tehsil / Sub-Division /District : Mant, Distt. Mathura
(h) State : Uttar Pradesh
(i) Category of the Dealership : SC
2 Details of existing / deceased / incapacitated proprietor / partner(s)
(a)
Name of Category Alive / Deceased / Existing % Wish to Proposed %
Proprietor/partner(s) SC/ST/Others Incapacitated share continue / share
retire
Virendra Singh Yadvendu SC Deceased 100% ------------

(b)
Name of Address Telephone / e-mail ID
Proprietor/partner(s) Mobile no.
Virendra Singh Yadvendu 5/208 nai abadi ram nagar 9412725918 [email protected]
shahganj agra

3 Details of Land on which Dealership is Mauza-Akbarpur, Khasra No. 51, Tentigaon,

located : Mant, Mathura
4 Whether proposal for reconstitution is being Death
submitted on account of Resignation / Death
/ Incapacitation / Others :
5 Name of the deceased or incapacitated 1.Virendra Singh Yadvendu
Proprietor / Partner(s), if same is applicable :
6 Details of nominee(s), in case appointed by deceased or incapacitated Proprietor / Partner(s) :
(a) Whether nominee(s) was appointed by NA
deceased or incapacitated Proprietor /
Partner(s) :
(b) Name(s) of person(s) last appointed as
nominee(s) by the deceased or incapacitated Name of deceased / Name of % of share
Proprietor / Partner(s), in case nominee(s) incapacitated nominee(s) nominated
Proprietor / Partner(s)
was/were appointed : (if more than one NA NA NA
nominee was appointed by the deceased or
incapacitated Dealer(s) in his last nomination,
details as indicated alongside has to be given
for each nominee indicating the % share out
 proposed by attaching separate sheet). If the
nominee(s) is/are minor, then the details of
the local guardian who will be operating the
dealership till the nominee(s) becomes a
major, is to be furnished along with that of
the minor nominee(s).
7 Detail of reconstitution proposed
(a) Whether reconstitution proposed for No
induction of outside partner(s) :
(b) Whether proposed for complete changeover Yes
in constitution :
(c) Whether dealership is eligible for complete Yes
change in constitution based on age of
Dealership :
(d) In case reconstitution is proposed within 3
years of commissioning of Dealership, NA
whether in the proposed reconstitution, 51 %
share is proposed % share out proposed, in case of death of Dealer(s) and
in case of incapacitation of Dealer(s), where the
incapacitated Dealer (s) desires to retire
i. In favour of originalallottee(s) and/or in In favour of original allottee(s) In favour of other
favour of nominee(s)/legal heir(s)/family and/ornominee(s)/legal incoming partner(s)
member(s) (including married children heir(s)/family member(s)
and/or grandchildren) of original (including married children
and/or grandchildren) of
allottee(s) where reconstitution is being
deceased / incapacitated
proposed due to death/ Incapacitation of Dealer(s)
Dealer(s) and where incapacitated Dealer
(s) desires to retire. % share out proposed In other cases
ii. In favour of original allottee(s) where In favour of existing partner(s) In favour of other
reconstitution is being proposed for incoming partner(s)
reasons other than death of the Dealer (s)
or is being proposed due to other cases.

The % share out of proposed reconstitution is

to be indicated as per table alongside.
(e) If the Dealership was allotted under SC/ST No
category, whether proposal is being
submitted for induction of other category
partner(s) :
(f) In case proposal is being submitted for Yes / No / NA
induction of partner(s) of other category in
Dealership allotted under SC/ST category, Name of partner(s) of SC/ST Continuing % of
whether total % share out proposed for other category / Incoming share
proposed
partner(s) is within 25 %. Also, mention total
share out proposed for other category
partner(s) : (In case of death/permanent
incapacitation of SC/ST Proprietor/Partner(s), Total % share proposed for
total share of the deceased/incapacitated partner(s) of SC/ST category
Proprietor/Partner(s) can be transferred to
Non-SC/ST spouse or Non-SC/ST children Name of partner(s) of other Continuing % of share
category / Incoming proposed
(legal heirs) as the case may be, which would
be counted as SC/ST share)

Total % share proposed for

partner(s) of other category

8 Brief reasons for the proposed reconstitution

:
9 Name(s) of continuing Proprietor / Partner(s)
/ incoming partner(s) : (if more than one Name of continuing Proprietor / % of share
partner is proposed, details as indicated Partner(s) proposed
below has to be given for each partner
indicating the % share out proposed). If the
legal heir(s) is/are minor, then the details of
the local guardian who will be operating the Name of incoming Proprietor / Partner(s) % of share
dealership till the legal heir(s) becomes a proposed
major, is to be furnished along with that of Asha Singh 100%
the minor legal heir(s). W/o Late Shri Virendra Singh Yadvendu

Signature of the incoming partner(s)

Signature of legal heir(s)

of deceased proprietor
 ANNEXURE-B2

UNDERTAKING

"I/We the existing Proprietor/Partner(s) M/s P.G. FILLING STATION a Retail Outlet Dealership
of Bharat Petroleum Corporation Ltd. At TENTIGAON, District :MATHURA, State UTTAR
PRADESH along with the proposed partner(s) hereby confirm that all the details furnished in
the application are true to the best of my/our knowledge. We also confirm that the re-constitution
policy has been read and understood by me/us. I/We confirm that the proposal for re-
constitution is submitted consciously after fully understanding the implications of the same."

Signature of the incoming partner

Signature of legal heir(s)

of deceased Proprietor
 ANNEXURE-C2
DETAILS OF CONTINUING PROPRIETOR / PARTNER(S) / INCOMING PROPRIETOR / PARTNER(S) FOR
RECONSTITUTION OF COMMISSIONED DEALERSHIP

Name of the continuing /

1 incoming Proprietor / ASHA SINGH
Partner(s)

Photograph of the continuing

2 / incoming Proprietor /
Partner(s)

Whether continuing /
3 incoming Proprietor / Incoming Proprietor
Partner(s)
Whether nominee of
4 deceased / incapacitated No
Proprietor / Partner(s)
Whether legal heir / family
member of deceased /
5 Yes
incapacitated Proprietor /
Partner(s)
Whether incoming Proprietor
6 / Partner(s) is outside / Within
within family
Category of continuing LOI
7 holder(s) / incoming SC
Proprietor / Partner(s)
8 % share proposed 100%
9 Address 5/208 Nai abadi ram nagar shahganj agra
10 District Agra
11 State Uttar Pradesh
12 PIN Code 282010
13 Telephone / Mobile no. 8171425558
14 e-mail Id [email protected]
Educational qualification as Bachelor in Arts (B.A)
15
on date of application Basic Training Certificate (B.T.C)
16 Date of birth 05/02/1969
17 Age as on date of application 49
18 Present occupation Housewife
19 PAN no. ASYPS8290G
Relationship details with Sole widow of the proprietor
20
deceased Proprietor, if any
Any other relevant
21
information

Signature of the incoming partner(s)

Signature of legal heir(s)
of deceased Proprietor
 DETAILS OF ANNEXURES FOR RECONSTITUTION OF COMMISSIONED DEALERSHIP

State attached
No. of
DOCUMENTS REQUIRED or not
pages
applicable

A. FOR INCOMING PARTNER

1. Proof of Identity :- Copy of any of the following (Voter ID / PAN Card YES 1
/ Photo ID card issued by Govt. / PSU / Passport / Driving Licence)
2. Age Proof :- Copy of any of the following ( Birth Certificate, School YES -
leaving certificate / Passport / Driving Licence / PAN Card / Self
Affidavit / Identity card issued by Election Commission)
3. Educational Qualification :- Copy of matriculation certificate / SSC / YES 1
10th passing marksheet.
4. Succession certificate / Legal heir certificate confirming legal heir(s) of YES 1
Proprietor / Partner(s)
5. Relinquishment deed (NOC) from YES 4
a. Nominee(s) / legal heir(s) of deceased Proprietor / Partner(s),in
case any nominee(s) / legal heir(s) is not proposing to join
dealership.
6. In case of reconstitution of SC/ST category Dealership with SC/ST N.A. -
partners – Copy of SC/ST Certificate from competent authority as per
Dealership Selection Guideline in vogue.
7. Standard Affidavit on Indian nationality, age, multiple dealership YES 3
norms, non-conviction etc. as applicable (Annexure-D2)
8. Passport size photographs of the continuing / incoming candidate(s) YES -
to be pasted on the application
9. If in service, affidavit for resigning from the service after the approval N.A. -
of reconstitution but before the execution of the agreement.
B. OTHER DOCUMENTS
1. Copy of last dealership agreement executed or reconstitution YES -
approval or copy of LOI/LOA, in case of first reconstitution
2. In case of SC/ST category copy of original LOI/LOA YES 3

3. Reconstitution Application Processing Fee (DD for Rs.25000/-) N.A. -

4. Draft copy of the dissolution deed of the existing partnership (if N.A. -
applicable).
5. Draft Copy of the deed of the proposed partnership (if applicable). N.A. -

6. Letter of Acceptance from the local guardian to operate the N.A. -

dealership till the legal heir becomes a major. (18 years)***
7. In case of incapacitation, copy of the Incapacitation Certificate issued N.A. -
by the Chief Medical officer of the District Govt. Medical Hospital /
Medical Board recognized by the Govt.
8. Age Proof of local guardian *** :- Copy of any of the following (Birth N.A. -
Certificate, School leaving certificate, Passport, Driving Licence, PAN
Card, Self Affidavit, Identity card issued by Election Commission).
9. Proof of educational qualification of the local guardian :If not able to N.A. -
furnish, he/she should be able to read, write & Count.
10. For induction of outside category partner in SC/ST dealership, N.A. -
incoming partner to fill the new dealership form and submit alongwith
relevant enclosures.
11. Copy of the latest audited balance sheet of the dealership YES 4

12. Recent certificate from Bank (issued within 3 months prior to the date YES 1
of application) giving the name(s) of account holders of the dealership
 as per bank account
13. Total no. of Pages enclosed 18

*** Required only if the proposed legal heir of the deceased/incapacitated LOI holder is a minor.

Signature of the incoming partner

Signature of legal heir(s)

of deceased Proprietor
 ANNEXURE–D2

Notarized Affidavit

(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

Reconstitution of Retail Outlet Dealership M/S P.G.FILLING STATION, atTENTIGAON, District :MATHURA,
State :UTTAR PRADESH

I,ASHA SINGH wife of LATE SHRI VIRENDRA SINGH YADVENDU Age 49 years residing at 5/208 NAI
ABADI RAM NAGAR SHAHGANJ AGRA do hereby solemnly affirm and say as under :

1 That I am an Indian Citizen and resident of India (as per Income Tax Rules).

2 That my date of birth is D D / M M / Y Y Y Y (Age as on date of application for reconstitution

in words FOURTY NINE YEARS )
0 5 0 2 1 9 8 6

* That I have passed the 10th Standard examination conducted by Board in the year Y Y Y Y
3
1 9 8 6

* That I am widow. That neither I nor my unmarried son(s)/unmarried daughter(s) have dealership/
4 distributorship or hold letter of Intent for Retail Outlet or SKO-LDO dealership or LPG distributorship of any Oil
Company except the subject Retail Outlet Dealership for which Reconstitution is proposed #..

5 That I hereby confirm that none of my family members (as per multiple dealership norms as defined in Dealer
Selection Guidelines of Oil Marketing Companies) are employees of Oil Marketing Companies.
 6 That I am of sound mental health & I am not totally paralyzed.

7 That I am married and my name before marriage was ASHA RANI and after my marriage to Shri VIRENDRA
SINGH YADVENDU has been changed to Smt ASHA SINGH.

8 That I have never been convicted by any Court of Law for any criminal offences involving moral turpitude
and/or economic offences (other than freedom struggle).

9 That I hereby confirm that I was never a signatory to dealership/distributorship agreement of any Oil
Company, which was terminated for proven malpractices and / or for violations of provisions of the Marketing
Discipline Guidelines.

10 That I hereby confirm that I will not be taking up any other employment upon my appointment as a dealer. If I
am already employed I will resign from the employment and produce the letter of acceptance of resignation by
the employer before the acceptance of Letter of Appointment issued by the Oil Company.

11 I hereby declare that I am neither employed in private sector nor drawing any salary/perks/emoluments from
State / Central Government. I also affirm that during the tenure of the Dealership I will not draw any salary
/perks/emoluments from State / Central Government / Private Sector.

12 That presently I am having a contract with an Oil Marketing Company as Service Provider/Labour
contractor/Job Contractor for one COCO RO

13 That if any information/declaration given by me in my application or in any document submitted by me in

support of application for the award of the RO dealership or in this affidavit shall be found to be untrue or
incorrect or false, then Corporation would be within its rights to withdraw the letter of intent / terminate the
dealership (if already appointed) and that I would have no claim, whatsoever, against the Corporation for such
withdrawal / termination.

* Strike off whatever is not applicable. # Strike off the portion in italics if not applicable.

I hereby verify that what has been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.

Signature of Deponent

ASHA SINGH

Solemnly affirmed and declared before me. This 15TH day of JANUARY.

Signature and Seal of

Magistrate/Judge/Notary public
 ANNEXURE-E2

AFFIDAVIT / INDEMNITY BOND FOR APPOINTMENT OF NOMINEE(S)

BY PROPRIETOR / PARTNER(S) OF COMMISSIONED DEALERSHIP

Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, I am the sole-Proprietor / Partner of M/s ____________________________ Retail Outlet

dealership of Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. located at ____________________, District : _____________,
State _______________ *along with Sri ___________________________________, son /
daughter / wife of ______________________________ Age _____ years residing at
__________________________ .

*That, the percentage share out of all the partners in the above stated RO dealership as per
Deed of Partnership no. _________ dated ________ is as indicated below;

* Name of Partner % Share Out

That, in case of my death or in case of any serious illness/accident which may lead to my
incapacitation resulting in total and permanent disability,which will disable me to work or follow
any occupation or profession, I hereby nominate Sri/Smt.
_______________________________ son / daughter / wife of
______________________________ Age _____ years residing at
__________________________ as my appointed nominee(s).

That, in case of my death or incapacitation resulting in total and permanent disability, Indian Oil
Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. will
be in its rights to reconstitute the above stated RO Dealership by inducting my appointed
nominee(s) Sri/Smt. _______________________________ son / daughter / wife of
______________________________ in the RO Dealership firm by allotting my share in the
above stated RO Dealership firm to my appointed nominee(s) as indicated below;

Name of the Nominee(s) Address % Share out If nominee is minor, name and
proposed address of person who will act
as Guardian

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Limited/
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. (as applicable) would
be within its rights to take suitable action as deemed fit including termination and that I would
have no claim, whatsoever againstIndian Oil Corporation Ltd. / Bharat Petroleum Corporation
Ltd. / Hindustan Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO Dealership by inducting my
appointed nominee(s) as Proprietor/partner(s).

Signature of Deponent (Proprietor/Partner)

(Name in block letters)

Witnessed by other Partner(s)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

First Class Magistrate/Executive Magistrate

* : Applicable only in case of partnership firm

 ANNEXURE-F2

AFFIDAVIT / INDEMNITY BOND BY NOMINEE(S) OF PROPRIETOR / PARTNER(S)

(to be obtained at time of reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, Sri/Smt. _______________________, son / daughter / wife of

_________________________ Age _____ years residing at __________________________
is the sole Proprietor / Partner of M/s ____________________________ Retail Outlet
dealership of Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. located at ____________________, District : _____________,
State _______________ *along with Sri ___________________________________, son /
daughter / wife of _________________________Age _____ years residing at
__________________________

*That, the percentage share out of all the partners in the above stated RO dealership as per
Deed of Partnership no. _________ dated ________ is as indicated below;

Name of Partner % Share Out

That, Sri/Smt. _______________________, has appointed me as his/her nominee vide affidavit

dated _________.

That, in view of death / incapacitation resulting in total and permanent disability, of Sri/Smt.
___________________________, I hereby request Indian Oil Corporation Ltd. / Bharat
Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. to induct me as sole
Proprietor / Partner for RO Dealership at ____________________, District : _____________,
State _______________ *along with Sri/Smt ___________________________________, son /
daughter / wife of ______________________________ Age _____ years residing at
__________________________ as per the share stated in the Affidavit dated _______ for
nomination submitted by Sri/Smt. ____________________________.

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Limited/
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. would be within its
rights to take suitable action as deemed fit including termination and thatI would have no claim,
whatsoever againstIndian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO Dealership by inducting me
as Proprietor/partner.

Signature of Nominee(s) of Proprietor/Partner(s)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

* : Applicable only in case of partnership firm

 ANNEXURE-G2

AFFIDAVIT / INDEMNITY BOND BY OTHER SURVIVING / EXISTING PARTNERS OF DEALERSHIP

IN CASE OF APPOINTMENT OF NOMINEE(S) BY ANY PARTNER
(Applicable only in case of Dealership under partnership and is to be obtained at time of
reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, I am the Partner of M/s ____________________________ Retail Outlet dealership of

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. located at ____________________, District : _____________, State
_______________ along with Sri ___________________________________, son / daughter /
wife of ______________________________ Age _____ years residing at
__________________________

That, the percentage share out of all the partners in the above stated RO dealership as per
Deed of Partnership no. _________ dated ________ is as indicated below;

Name of Partner % Share Out

That, Sri/Smt. _______________________, who is my partner in the above stated RO

dealership had appointed Sri/Smt. __________________ son / daughter / wife of
_____________________________ Age _____ years residing at
__________________________ as his/her nominee vide affidavit dated _________.

That, in view of death / incapacitation resulting in total and permanent disability, of Sri/Smt.
___________________________, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation
Ltd. / Hindustan Petroleum Corporation Ltd. is requested to induct his / her nominee(s) Sri/Smt.
__________________as partner in the RO Dealership at __________________, District :
_____________, State ___________along with me and Sri/Smt
_________________________, son / daughter / wife of ______________________________.

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false,Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.
I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO Dealership by inducting
Sri/Smt. _________________ as partner in the Dealership.

Signature of Deponent {surviving partner(s)}

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public
 ANNEXURE-H2

AFFIDAVIT / INDEMNITY BOND BY SURVIVING PARTNERS OF DEALERSHIP

(Applicable only in case of Dealership under partnership and is being reconstituted in favour of only
surviving partners in case Nominee(s) / Legal heir(s) of deceased partner(s) is/are not available / not
traceable - to be obtained at time of reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,_________________________ son / daughter / wife of ______________________________

Age _____ years residing at __________________________ do hereby solemnly affirm and
say as under;

That, I am the Partner of M/s ____________________________ Retail Outlet dealership of

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. located at ____________________, District : _____________, State
_______________ along with Sri ___________________________________, son / daughter /
wife of ______________________________ Age _____ years residing at
________________________

That, the percentage share out of all the partners in the above stated RO dealership as per
Deed of Partnership no. _________ dated ________ is as indicated below;

Name of Partner % Share Out

That, Sri/Smt. _______________________, who is my partner in the above stated RO

dealership expired / got totally incapacitated on ______________. That, Sri/Smt.
_______________________, hadearlier appointed Sri/Smt. __________________ son /
daughter / wife of _____________________________ Age _____ years residing at
__________________________ as his/her nominee vide affidavit dated _________. That, vide
his/her affidavit dated ___________ Sri/Smt. _______________________ had requested Indian
Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd.
to reconstitute the above stated RO dealership in the event of his/her death/incapacitation
resulting in total and permanent disability, by inducting Sri/Smt. ______________________ as
partner in the dealership in lieu of him/her, as per shareholding allocated by him/her. That,
Sri/Smt. _____________________ who was appointed as nominee by
Sri/Smt.________________ is not available / is not traceable.

Or

That, Sri/Smt. _______________________, who is my partner in the above stated RO

dealership expired / got totally incapacitated on ______________. That, Sri/Smt.
_______________________ son / daughter / wife of _____________________ Age _____
years residing at _____________________ is/are the Legal heirs of Sri/Smt.
__________________________. That, Sri/Smt. _____________________ who is the legal heir
of Sri/Smt. ________________ is not available/ is not traceable.
 Or

That, Sri/Smt. _______________________, who is my partner in the above stated RO

dealership expired / got totally incapacitated on ______________. That, there is no surviving
Legal heir of deceased Sri/Smt. ________________.

In view of above, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. is requested to reconstitute the above stated Dealership as per
share holding indicated below;

Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated Dealership.

Signature of Deponent (Surviving Partner(s)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public
 ANNEXURE-I2

AFFIDAVIT / INDEMNITY BOND BY LEGAL HEIR(S) & SURVIVING PARTNERS OF DEALERSHIP

(Applicable only in case of some/all nominee(s) / Legal heir(s) of deceased Proprietor/Partner(s) is/are
not responding and Dealership is being reconstituted in favour of responding nominee(s) / Legal
heir(s) / surviving partners - to be obtained at time of reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, I am the Partner of M/s ____________________________ Retail Outlet dealership of

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. located at ____________________, District : _____________, State
_______________ along with Sri ___________________________________, son / daughter /
wife of ______________________________ Age _____ years residing at
________________________

Or

That, Sri/Smt. _______________________,Proprietor / partner of M/s

____________________________ Retail Outlet dealership of Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. located at
____________________, District : _____________, State _______________ has appointed me
and Sri/Smt._____________________ as his/her nominee vide affidavit dated _________.

Or

That, I and Sri/Smt. __________________________son / daughter / wife of

_____________________ Age _____ years residing at _____________________ are the
Legal heirs of Sri/Smt. _______________________,Proprietor / partner of M/s
____________________________ Retail Outlet dealership of Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. located at
____________________, District : _____________, State _______________

That, the percentage share out of all the partners in the above stated RO dealership as per
Deed of Partnership no. _________ dated ________ is as indicated below;

Name of Existing Partners % Share Out

That, Sri/Smt. _______________________, the partner of the above stated RO dealership

expired / got totally incapacitated on ______________.
That, Sri/Smt. _____________________ who is the nominee/legal heir of Sri/Smt.
____________________ is not interested to join the above stated dealership / is not
responding.

That, in view of death / incapacitation resulting in total and permanent disability, of Sri/Smt.
_________________________ and as Sri/Smt. _____________________ is not interested to
join the above stated dealership / not responding, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd. is requested to reconstitute the above
stated RO Dealershipat ____________________, District : _____________, State
_______________ as per the share out stated below;

Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO Dealership.

Signature of Deponent {surviving Partner(s)/Legal Heir(s)}

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public
 ANNEXURE-J2

AFFIDAVIT / INDEMNITY BOND BY ELIGIBLE LEGAL HEIR(S) & SURVIVING PARTNERS OF DEALERSHIP

(Applicable only in case of reconstitution cases where there is no NOCs from Nominee(s)/Legal Heir(s)
who are not eligible to become Dealer(s) - to be obtained at time of reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, I am the Partner of M/s ____________________________ Retail Outlet dealership of

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. located at ____________________, District : _____________, State
_______________ along with Sri/Smt. ___________________________________, son /
daughter / wife of ______________________________ Age _____ years residing at
________________________

Or

That, I and Sri/Smt. __________________ son / daughter / wife of _____________________

Age _____ years residing at _____________________are the Legal heirs of Sri/Smt.
_______________________,who is the proprietor / partner of M/s
____________________________ Retail Outlet dealership of Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. located at
____________________, District : _____________, State _______________

That, the percentage share out of all the partners in the above stated RO dealership as per
Deed of Partnership no. _________ dated ________ is as indicated below;

Name of Existing Partners % Share Out

That, Sri/Smt. _______________________, theproprietor/partner of the above stated RO

dealership expired / got totally incapacitated on ______________.

That, Sri/Smt.___________________ who is also the Nominee/Legal heir of deceased / totally

incapacitated proprietor/partner Sri/Smt. _______________________, is not eligible to become
a dealer as per eligibility criteria / disqualification criteria of RO Dealership Selection Guidelines
in vogue.
That, Sri/Smt._____________________ is not tendering her No-Objection towards
reconstitution of the above stated RO dealership with me as a partner, in-spite of he/she not
being eligible to become a dealer as per eligibility criteria / disqualification criteria of RO
Dealership Selection Guidelines in vogue.

That, in view of death / incapacitation resulting in total and permanent disability, of Sri/Smt.
___________________________ and as Sri/Smt. _______________________, is not eligible
to become a dealer as per eligibility criteria / disqualification criteria of RO Dealership Selection
Guidelines in vogue, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. is requested to reconstitute the above stated RO Dealership at
____________________, District : _____________, State _______________ as per the share
out stated below, without waiting for No-Objection certificate from Sri/Smt.
_________________.

Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO Dealership.

Signature of Deponent (surviving Partner(s) / eligible Legal Heirs)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public
 ANNEXURE-K2

AFFIDAVIT / INDEMNITY BOND BY CLAIMANT / PROSPECTIVE DEALER OF DEALERSHIP

(Applicable in case of reconstitution where copy of Dealership Agreement is not available - to be

obtained at time of reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per copy of Selection panel dated __________________ / LOI no.

______________dated __________ / LOA no. _______________ dated ______________ /
copy of reconstitution approval no. _______________ dated ________________, I/we am/are
the proprietor/ partners in the above mentioned RO dealership as per the following approved
constitution;

Or

That, as per copy of copy of income tax return for the period __________ / sales tax registration
no. ___________ and/orsales tax returns for the period _____________ / RSL dated
______________ or (any other record / correspondence) I/we am/are the proprietor/ partners in
the above mentioned RO dealership as per the following approved constitution;

Name of Existing Proprietor / Son / Daughter / wife of % Share Out

Partner(s)

That, the Dealership Agreement of the above stated RO Dealership is not traceable.

In view of above, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltdis requested to take cognizance of the above stated Primary /
Secondary documents andexecute a fresh Dealership Agreement as per the constitution stated
hereinabove.

That, I hereby verify that what has been stated above is true and correct to the best of my
knowledge and nothing material has been concealed there from.If any information/declaration
given by me in this affidavit shall be found to be untrue or incorrect or false, Indian Oil
Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd
would be within its rights to take suitable action as deemed fit including termination and that I
would have no claim, whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd. (as applicable) for such action.
I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO Dealership.

Signature of Deponent (claimant / prospective dealers)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public
 ANNEXURE-L2

AFFIDAVIT / INDEMNITY BOND BY PROCLAIMED LEGAL HEIRS OF PROPRIETOR / PARTNER(S)

(Applicable in case wherereconstitution have not been done due to non-availability / authenticity of
legal heir(s) but is being operated by proclaimed legal heir(s))
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of theRO dealership as per shareholding indicated below;

Name of Proprietor /Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, Sri/Smt. ________________________expired / got totally incapacitated on __________

and since them I and Sri/Smt. __________________ son / daughter / wife of
_____________________ Age _____ years residing at _____________________ who are
the Legal heirs of Sri/Smt. _______________________ has been peacefully and without
dispute running the above stated Retail Outlet dealership as per shareholding indicated below
since ____________, without obtaining prior approval from Indian Oil Corporation Ltd. / Bharat
Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd.;

Name of Proclaimed Legal Son / Daughter / wife of % Share Out

Heirs operating the Dealership

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd is requested to take cognizance of the above and condone the mistake
committed by us and reconstitute the above stated RO Dealership by inducting me/us as per the
shareholding indicated above.

That, I/we further confirm to have gone through and fully understood various clauses of the
dealership agreement and would fully comply by the same in future.

That, I/we undertake to take full responsibility of our actions in the past and verify that what has
been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.If any information/declaration given by me in this affidavit shall be
found to be untrue or incorrect or false, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its rights to take
suitable action as deemed fit including termination and that I would have no claim, whatsoever
against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) for such action.
successors, executors, assigns and administrators hereby also indemnify Indian Oil Corporation
Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. (as applicable)
from all acts, disputes, costs, losses, claims, damages, suits or any other risks arising out of
reconstitution of the above stated RO Dealership and for our actions in the past.

Signature of Deponent (claimant / prospective dealers)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-M2
 AFFIDAVIT / INDEMNITY BOND BY REMAINING PARTNER(S)

(Applicable in casewhere dealership is being operated by one or more partners after exit or prolonged
absence of partner(s) from the dealership without approval of OMCs)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per Dealership Agreement dated _____________________ the following are the
approved partners of theRO dealership as per shareholding indicated below;

Name of Partner(s) as per Son / Daughter / wife of % Share Out

Dealership Agreement

That, Sri/Smt. ________________________ had exited the RO Dealership / is absent from the
RO Dealership since _____________, without obtaining any prior approval from Indian Oil
Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd.

That, I/we have been peacefully and without dispute running the above stated Retail Outlet
dealership as per shareholding indicated below since ____________, without obtaining prior
approval from Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd.;

Name of Partner(s) operating Son / Daughter / wife of % Share Out

the Dealership

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd is requested to take cognizance of the above and condone the mistake
committed by us and reconstitute the above stated RO Dealership by inducting me/us as per the
shareholding indicated above.

That, I/we further confirm to have gone through and fully understood various clauses of the
dealership agreement and would fully comply by the same in future.

That, I/we undertake to take full responsibility of our actions in the past and verify that what has
been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.If any information/declaration given by me in this affidavit shall be
found to be untrue or incorrect or false, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its rights to take
suitable action as deemed fit including termination and that I would have no claim, whatsoever
against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) for such action.

I/wealong with my/our heirs, nominees, successors, executors, assigns and administrators
hereby also indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. /
Hindustan Petroleum Corporation Ltd. (as applicable) from all acts, disputes, costs, losses,
claims, damages, suits or any other risks arising out of reconstitution of the above stated RO
Dealership and for our actions in the past.

Signature of Deponent (claimant / prospective dealers)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-N2

AFFIDAVIT / INDEMNITY BOND BY PROPRIETOR / PARTNER(S)

(Applicable in casewhere constitution is currently in line with approved set up and past deviations have
been rectified)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of theRO dealership as per shareholding indicated below;

Name of Proprietor / Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, the constitution of the RO Dealership was changed by me/us on _____________ without
obtaining prior approval of the Corporation, however subsequently I/we have restored the
constitution of the firm to its last approved setup as per the Dealership Agreement effected on
________.

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd is requested to take cognizance of the above and condone the mistake
committed by us and allow rectification / restoration of the constitution of the above stated RO
Dealership to its’ earlier approved constitution (set-up) of the dealership.

That, I/we further confirm to have gone through and fully understood various clauses of the
dealership agreement and would fully comply by the same in future.

That, I/we undertake to take full responsibility of our actions in the past and verify that what has
been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.If any information/declaration given by me in this affidavit shall be
found to be untrue or incorrect or false, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its rights to take
suitable action as deemed fit including termination and that I would have no claim, whatsoever
against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) for such action.

I/we along with my/our heirs, nominees, successors, executors, assigns and administrators
hereby also indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. /
Hindustan Petroleum Corporation Ltd. (as applicable) from all acts, disputes, costs, losses,
claims, damages, suits or any other risks arising out of reconstitution of the above stated RO
Dealership and for our actions in the past.
 Signature of Deponent {Proprietor/Partner(s)}
(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-O2

AFFIDAVIT / INDEMNITY BOND BY INDUCTEES

(Applicable in casewhere proposed constitution requires recognition of induction of Partner(s) in the
past without approval of OMC)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of theRO dealership as per shareholding indicated below;

Name of Proprietor / Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, without obtaining prior approval of the Corporation, the constitution of the above statedRO
Dealership was changed by me/us on _____________ by inducting
Sri/Smt.__________________ son / daughter / wife of _____________________ Age _____
years residing at _____________________as partner(s) with shareholdings as indicated below;

Name of partner(s) of Son / Daughter / wife of Within family / % Share Out

current constitution Outside family

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd is requested to take cognizance of the above and condone the mistake
committed by me/us and reconstitute the above stated RO Dealership as per the shareholding
indicated above.

That, I/we further confirm to have gone through and fully understood various clauses of the
dealership agreement and would fully comply by the same in future.

That, I/we undertake to take full responsibility of our actions in the past and verify that what has
been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.If any information/declaration given by me in this affidavit shall be
found to be untrue or incorrect or false, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its rights to take
suitable action as deemed fit including termination and that I would have no claim, whatsoever
against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) for such action.
I/wealong with my/our heirs, nominees, successors, executors, assigns and administrators
hereby also indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. /
Hindustan Petroleum Corporation Ltd. (as applicable) from all acts, disputes, costs, losses,
claims, damages, suits or any other risks arising out of reconstitution of the above stated RO
Dealership and for our actions in the past.

Signature of Deponent (claimant / prospective dealers)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-P2

AFFIDAVIT / INDEMNITY BOND BY INDUCTEES

 (Applicable in case of total change over in past where proposed constitution requires approval for
induction of "family member(s)” or “blood relative” of approved signatory)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of theRO dealership as per shareholding indicated below;

Name of Proprietor / Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, I being ________________ of Sri/Smt. ________________________, who is the

proprietor/partner of the above mentioned RO Dealership, is his/her family member / blood
relative.

That, without obtaining prior approval of the Corporation, the constitution of the above stated
RO Dealership was changed by me/us on _____________ as per the shareholdingsindicated
below;

Name of partner(s) of Son / Daughter / wife of % Share Out

current constitution

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd is requested to take cognizance of the above and condone the mistake
committed by me/us and reconstitute the above stated RO Dealership as per the shareholding
indicated above.

That, I/we further confirm to have gone through and fully understood various clauses of the
dealership agreement and would fully comply by the same in future.

That, I/we undertake to take full responsibility of our actions in the past and verify that what has
been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.If any information/declaration given by me in this affidavit shall be
found to be untrue or incorrect or false, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its rights to take
suitable action as deemed fit including termination and that I would have no claim, whatsoever
against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) for such action.

I/wealong with my/our heirs, nominees, successors, executors, assigns and administrators
hereby also indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. /
Hindustan Petroleum Corporation Ltd. (as applicable) from all acts, disputes, costs, losses,
claims, damages, suits or any other risks arising out of reconstitution of the above stated RO
Dealership and for our actions in the past.

Signature of Deponent (claimant / prospective dealers)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-Q2

AFFIDAVIT / INDEMNITY BOND BY INDUCTEES

 (Applicable in case of total change over in past where no signatory {including legal heir(s)/ family
member(s)/blood relative(s)} is part of set up)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, M/s. _____________________, at ____________________, District : _____________,

State _______________, has been operating as a duly approved Retail Outlet dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. since __________.

That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of theRO dealership as per shareholding indicated below;

Name of Proprietor / Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, without obtaining prior approval of the Corporation, the constitution of the above stated
RO Dealership was changed by me/us on _____________ as per the shareholdings indicated
below;

Name of partner(s) of Son / Daughter / wife of % Share Out

current constitution

Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd is requested to take cognizance of the above and condone the mistake
committed by me/us and reconstitute the above stated RO Dealership as per the shareholding
indicated above.

That, I/we further confirm to have gone through and fully understood various clauses of the
dealership agreement and would fully comply by the same in future.

That, I/we undertake to take full responsibility of our actions in the past and verify that what has
been stated above is true and correct to the best of my knowledge and nothing material has
been concealed there from.If any information/declaration given by me in this affidavit shall be
found to be untrue or incorrect or false, Indian Oil Corporation Ltd. / Bharat Petroleum
Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its rights to take
suitable action as deemed fit including termination and that I would have no claim, whatsoever
against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) for such action.
I/wealong with my/our heirs, nominees, successors, executors, assigns and administrators
hereby also indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. /
Hindustan Petroleum Corporation Ltd. (as applicable) from all acts, disputes, costs, losses,
claims, damages, suits or any other risks arising out of reconstitution of the above stated RO
Dealership and for our actions in the past.

Signature of Deponent (claimant / prospective dealers)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-R2
 AFFIDAVIT / INDEMNITY BOND BY MEMBERS OF “FAMILY UNIT” AND MARRIED CHILDREN OF
TOTALLY INCAPACITATED DEALER(S).

(Applicable only in case of reconstitution cases where there is no nominee(s) and totally incapacitated
Dealer(s) is not in a position to give consent due to physical condition - to be obtained at time of
reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, Sri/Smt. _______________________, son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ is the proprietor / partnerof the Retail Outlet Dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. at the location ____________________, District : _____________, State
_______________ *along with Sri/Smt ___________________________________, son /
daughter / wife of ______________________________ Age _____ years residing at
__________________________ .

*That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of the RO dealership as per shareholding indicated below;

Name of Proprietor / Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, Sri/Smt. ___________________, who is the proprietor/partner of the above stated RO

dealership got totally incapacitated on ______________ due to ____________________ and is
not in a position to give his/her consent in respect of reconstitution of his/her above stated RO
dealership, owing to his/her physical condition.

That, I being the _________________ of Sri/Smt. _______________________ is a member of

his / her “Family Unit”.

That, in view of death / incapacitation resulting in total and permanent disability, of Sri/Smt.
___________________________ and as he / she is not in a position to give his/her consent in
respect of reconstitution of his/her above stated RO dealership, due to his/ her physical
condition, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. is requested to reconstitute the above stated RO dealership at
____________________, District : _____________, State _______________ as per the share
out stated below,
 Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO dealership.

Signature of Deponent (Member of family unit / Married children)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-S2
AFFIDAVIT / INDEMNITY BOND BY LEGAL HEIR(S) OF DEALER(S)
 (Applicable only in case of reconstitution cases where Legal Heir(s) have applied for Succession
Certificate but have not been able to obtain it due to pending court proceedings - to be obtained at
time of reconstitution)
Notarized Affidavit
(TO BE TYPED ON APPROPRIATE NON-JUDICIAL STAMP PAPER OF REQUIRED VALUE)

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ do hereby solemnly affirm and say as under;

That, Sri/Smt. _______________________, son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ is the proprietor / partner of Retail Outlet Dealership of Indian
Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd.
at location ____________________, District : _____________, State _______________ *along
with Sri/Smt ___________________________________, son / daughter / wife of
______________________________ Age _____ years residing at
__________________________ .

*That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of the RO dealership as per shareholding indicated below;

Name of Proprietor / Partner(s) Son / Daughter / wife of % Share Out

as per Dealership Agreement

That, Sri/Smt. _______________________, theproprietor / partner of the above stated RO

Dealership expired / got totally incapacitated on ______________.

That, I and Sri/Smt._________________________ son / daughter / wife of

_____________________ Age _____ years residing at _____________________ are the
Legal heir(s) of deceased / totally incapacitated proprietor / partner of Retail Outlet Dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. at location ____________________, District : _____________, State
_______________

That, vide application no. _____________ dated __________,I have submitted an application /
petition to the Hon’ble Court at __________ for recognizing me as Legal heir of deceased /
totally incapacitated proprietor / partner Sri/Smt. _______________________, by issuing a
Succession Certificate. However, due to pending proceedings by the Hon’ble court, succession
certificate could not be issued till date. Further, it expected that the issuance of Succession
Certificate will take some more time.

That, in view of death / incapacitation resulting in total and permanent disability, of Sri/Smt.
_________________________ and as it is expected that the competent authority will take some
more time to issue a succession certificate to the effect that I am the Legal Heir of deceased /
totally incapacitated proprietor / partner Sri/Smt. __________________, Indian Oil Corporation
Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd. is requested to
recognize me as the Legal heir of deceased / totally incapacitated proprietor / partner Sri/Smt.
__________________, and reconstitute the above RO dealership at ____________________,
District : _____________, State _______________ as per the share out stated below;

Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO dealership.

Signature of Deponent {Legal heir of Proprietor/Partner(s)}

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

ANNEXURE-T2
AFFIDAVIT / INDEMNITY BOND BY OUTGOING PROPRIETOR/PARTNER(S) LIVING OUTSIDE COUNTRY

(Applicable only in case of reconstitution cases where outgoing partner living outside country cannot
attend meeting of existing/incoming proprietor/partner(s) at Divisional/Territory/Regional Office - to
be obtained at time of reconstitution)
Affidavit

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years resident of
__________________________ currently residing at __________________________ do
hereby solemnly affirm and say as under;

That, I *along with Sri/Smt. _______________________, son / daughter / wife of

______________________________ Age _____ years residing at
__________________________ am/are the proprietor / partners of Retail Outlet Dealership of
Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. at location ____________________, District : _____________, State
_______________.

*That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of the RO dealership as per shareholding indicated below;

Name of existing Proprietor / Son / Daughter / wife of % Share Out

Partner(s) as per Dealership
Agreement

That, due to my permanent / temporary residency status of ________________ since

______________ I am unable to continue as proprietor / partner of the above stated RO
Dealership and therefore want to resign from the dealership.

That, vide docket no. _____________ dated __________, an application have been submitted
for reconstituting the above mentioned RO Dealership as indicated below;

Name of proposed Proprietor / Son / Daughter / wife of % Share Out

Partner(s)

That, vide letter no. ______________ dated ___________, the Divisional/Territory/Regional

Office in-charge of Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. has advised me to attend the meeting of existing/in-coming
proprietor/partner(s) at _______________ on ________________.

That, due to _________________, I will not be to attend the above stated meeting.

That, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. is requested to approve the reconstitution proposal submitted vide docket no.
___________ andreconstitute the above RO dealership at ____________________, District :
_____________, State _______________ as per the share out stated below;

Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO dealership.

Signature of Deponent (Proprietor/Partner living outside India)

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Authorized personnel of
Indian Consulate at ________________

ANNEXURE-U2
AFFIDAVIT / INDEMNITY BOND BY OTHER EXISTING/INCOMING PARTNER(S) LIVING IN INDIA
(Applicable only in case of reconstitution cases where outgoing partner living outside country cannot
attend meeting of existing/incoming proprietor/partner(s) at Divisional/Territory/Regional Office - to
be obtained at time of reconstitution)
Affidavit

I,____________________________________ son / daughter / wife of

______________________________ Age _____ years resident of
__________________________ currently residing at __________________________ do
hereby solemnly affirm and say as under;

That, Sri/Smt. _______________________, son / daughter / wife of

_________________________ Age _____ years residing at __________________________
is the sole Proprietor / Partner of M/s ____________________________ Retail Outlet
dealership of Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. located at ____________________, District : _____________,
State _______________ *along with Sri ___________________________________, son /
daughter / wife of _________________________Age _____ years residing at
__________________________

*That, as per Dealership Agreement dated _____________________ the following are the
approved proprietor/ partners of the RO dealership as per shareholding indicated below;

Name of existing Proprietor / Son / Daughter / wife of % Share Out

Partner(s) as per Dealership
Agreement

That, Sri/Smt. ______________________ is currently a temporary / permanent resident of

________________ since ____________.

That, due to the permanent / temporary residency status of ________________ since

______________ he/she is unable to continue as proprietor / partner of the above stated RO
Dealership and therefore has proposed to resign from the dealership.

That, vide docket no. _____________ dated __________, an application have been submitted
for reconstituting the above mentioned RO Dealership as indicated below;

Name of proposed Proprietor / Son / Daughter / wife of % Share Out

Partner(s)

That, vide letter no. ______________ dated ___________, the Divisional/Territory/Regional

Office in-charge of Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. has advised me along with Sri/Smt. ______________________ to
attend the meeting of existing/in-coming proprietor/partner(s) at _______________ on
________________.
That, due to _________________, Sri/Smt __________________ has informed that he/she will
not be able to attend the above stated meeting.

That, Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. is requested to approve the reconstitution proposal submitted vide docket no.
___________ and reconstitute the above RO dealership at ____________________, District :
_____________, State _______________ as per the share out stated below;

Name of Proposed Proprietor/Partner(s) % Share Out

I hereby verify that what has been stated above is true and correct to the best of my knowledge
and nothing material has been concealed there from.If any information/declaration given by me
in this affidavit shall be found to be untrue or incorrect or false, Indian Oil Corporation Ltd. /
Bharat Petroleum Corporation Ltd. / Hindustan Petroleum Corporation Ltd would be within its
rights to take suitable action as deemed fit including termination and that I would have no claim,
whatsoever against Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd. (as applicable) for such action.

I along with my heirs, nominees, successors, executors, assigns and administrators hereby also
indemnify Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan Petroleum
Corporation Ltd. (as applicable) from all acts, disputes, costs, losses, claims, damages, suits or
any other risks arising out of reconstitution of the above stated RO dealership.

Signature of Deponent {Incoming Proprietor/Partner(s)}

(Name in block letters)

Solemnly affirmed and declared before me. This ___________day of ________________

Signature and Seal of

Magistrate/Judge/Notary public

I/wealong with my/our heirs, nominees,

 APPENDIX-I

LETTER OF WARNING TO BE ISSUED BY DIVISIONAL/TERRITORY/REGIONAL OFFICE IN-CHARGE

Ref :,____________________________ Date : ____________________

To,
M/s ________________________
(Name & Location of Dealership)

Sub : Warning Letter.

Dear Sir(s) / Madam,

We are in receipt of your proposal wherein you have confirmed that the constitution of the
Dealership was changed by you without obtaining prior approval of the Corporation, and now
you have made a request for approving the same set-up with induction of partner(s) from within
Legal heirs / family members / blood relative / outside partners.

You have further confirmed to have gone through and fully understood various clauses of the
Dealership Agreement and would fully comply by the same in future.

The Corporation has taken cognizance of the above mistake committed at your end and in view
of your request for condoning the same, and the proposal meeting the extant guidelines, would
like to convey the approval now.

Further, you are hearby cautioned that such changes in the constitution without prior approval of
the Corporation are against the policy guidelines and in case of any further instance, we would
be constratined to take suitable action against the dealership as per policy in vogue and
relevant clauses of the Dealership Agreement.

The above is issued without any prejudice and in order to protect marketing interests of the
Corporation.

Thanking you.

Yours faithfully,
For & On behalf of Indian Oil Corporation Ltd. / Bharat Petroleum Corporation Ltd. / Hindustan
Petroleum Corporation Ltd.

(Name & Designation of DIVISIONAL/TERRITORY/REGIONAL OFFICE IN-CHARGE)