Sample self declaration form for multiple usage

1. Self – Declaration for Proprietorship
(To be given on the Letterhead of the FBO/Firm/Company)
I, ______________, S/o/D/o/W/o _________________, R/o ___________________, do
hereby state and affirm as follows:
That I am the sole owner/ proprietor of a business operating under the name and style of “……………” <Insert
Name of business> operating from………….… <Insert business address> and I shall do the business of ………………
<Insert the nature of business>.
That I am carrying on a bona fide business and have complied with all laws and regulations and that all registrations,
authorizations, licenses and/permissions required for carrying on business have been obtained by me.
That I am the sole proprietor of the firm and am solely responsible for the liabilities thereof. I shall inform you in
writing of any change in the constitution of the firm and shall be personally liable to you for all liabilities which my
firm may incur in the course of its dealings with you and I shall personally be responsible for such liabilities.
It is also to declare that below mentioned person is my legal nominee for the said proprietorship concern
………………
Relationship with the proprietor ….……………
That my above declarations are true and correct to the best of my knowledge and belief, in case, my above
declaration found incorrect, in that event, Just Dial shall be fully competent to take the necessary action as deemed
fit.
Signatures of the proprietor with Stamp/ Seal
Name:
Address:
Contact Nos
Date:
Place: