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Erstand that any false declaration attracts punishment under Indian Penal Code. Place Date Signature of the Consumer ACKNOWLEDGEMENT SLIP Received Non Aadhaar Cash Transfer mandate Form 4 from (Name) Ms. SAMIKSHA DANGWAL Con. No 27272 along with copy of passbook/cancelled cheque. Date Sign & stamp of LPG Distributor Page 1/1 Powered by TCPDF (www.tcpdf.org) 5 2.

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