Affidavit Format (Lost Mark sheet/Degree Certificate)

AFFIDAVIT OF Mr. / Ms. _______________________________________________________

I, _________________________________________________________________________
S/O _____________________________ aged about _____________years and residing at
___________________________________________________________________________
___________________ do hereby solemnly affirm and sincerely state as follows: I take full
responsibility for the loss in particular and any resultant acts/omissions/commissions that
may be caused due to the said loss of Mark sheet/Degree certificate. I state that I have lost
my ____________ Mark sheet / degree certificate (Roll No. _____________) given in the year
_________________ and if I do manage to recover or find the original ___________
certificate, I shall return the duplicate certificate to the concerned authorities at Calorx
Teachers’ University. The above mentioned facts are true and correct to the best of my
knowledge, information and belief.

Signature of the Deponent Solemnly affirmed at ____________ on this _______ day of

___________

Deponent signed before me and signed his/her name in my presence Seal of the Notary