AFFIDAVIT

ENGLISH ACCESS MICROSCHOLARSHIP PROGRAM

I, ___________________ S/D/O _____________________, dated_________, hereby
confirm that I have received the tablet bearing EMI No.__________________. It is the
property of US Embassy Pakistan and is being awarded to me on securing my admission in
English Access Microscholarship Program.
Terms and conditions
I confirm that I will
● Not damage the tablet
● Sell the tablet
● If due to any reason my candidature is cancelled, I will return the tablet.
● If during the course I have to leave due to any reason, I will return the tablet.
● Return the tablet to the concerned authorities after the completion of the course.
I also confirm that I will be held accountable and have to pay fine, if I am unable to return
the tablet to concerned authorities.

Applicant Name _________________ Father/Guardian Name ____________________

Applicant signature ______________ Father/Guardian Signature _________________

Applicant Contact No. ____________ Father/Guardian Contact Number___________

Applicant B-Form/CNIC No.__________________

Farher/Guardian CNIC No. ________________

Date: ___________