AFFIDAVIT –CUM-UNDERTAKING DULY NOTARIZED TO BE SUBMITTED ON

NON-JUDICIAL STAMP PAPER OF RS 100/- ALONG WITH THE APPLICATION

1. I/We hereby declare that our Assaying & Hallmarking Centre has legal identity.

2. I/We also declare that there has been no conviction of promoter(s) or any of their close
relatives for any criminal offence in the last five years.

3. I/We also declare that none of the promoter(s) or any of their close relatives has/have been
involved in any serious irregularity in the running of any other Assaying & Hallmarking Centre
during the last five years.

4. I/We hereby declare that the following jewellery firms holding BIS licence are owned by
my/our relatives*.
Sl. Name of the Name of the relative(s) Name and address BIS Licence No. of
No. Proprietor/Partner(s) owning jewellery firm & of the jewellery the jewellery firm
/Director(s) of the their relationship with firm
A&H Centre name in col 2
(1) (2) (3) (4) (5)

5. I/We declare that in case of any change in the list of jewellery firms as listed above, I/We
shall immediately intimate BIS about such change.

6. I/We declare that my/our A&H Centre shall not accept any jewellery/artefact for hallmarking
from any of the above mentioned jewellery firms.

7. I/We understand that in case the above declaration is found to be false by BIS at any stage,
the recognition granted to my/our A&H Centre is liable to be cancelled.

8. I/We declare that I/we have read and understood the Policy for Recognition and Operation of
Assaying & Hallmarking Centres and shall comply with all the provisions of this policy as amended
from time to time.

Signature
(Proprietor/Partner/Director)
Name
Designation
Seal
Date
Place

Note:
*Relative’ with reference to any person, shall means anyone who is related to another, if—
a) they are members of a Hindu Undivided Family;
b) they are husband and wife; or
c) if he or she is related to another in the following manner, namely:-
i. Father: Provided that the term “Father” includes step-father.
ii. Mother: Provided that the term “Mother” includes the step-mother.
iii. Son: Provided that the term “Son” includes the step-son.
iv. Son’s wife.
v. Daughter.
vi. Daughter’s husband.
vii. Brother: Provided that the term “Brother” includes the step-brother;
viii. Sister: Provided that the term “Sister” includes the step-sister.