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13 NOTARY FORM For Lost of Original Certificates

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63 views1 page

13 NOTARY FORM For Lost of Original Certificates

Uploaded by

shalu629467
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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AFFIDAVIT TO BE FILLED FOR ISSUE OF DUPLICATE CERTIFICATE

AFFIDAVIT of Thiru / Selvi _________________________________________________

1. I ________________________________________________________________________

son/daughter of _______________________________________ aged ________ years,

an old student /student of Hindusthan College of Engineering and Technology with

Register Number __________________ and residing at

_______________________________________

________________________________________________________________ do hereby

solemnly and sincerely state as follows.

2. My ____________________Semester Grade Sheet* issued relating to the

examinations held during _____________________/ Consolidated Statement of

Grades* issued by the college has irrevocably been lost / destroyed.

3. I fill this affidavit for the purpose of receiving duplicate certificate.


4. The duplicate certificate shall be returned to the college once my original
certificate(s) is/are recovered by chance.
5. The facts stated are true and correct to the best of my knowledge and if found false
by the college, I shall abide by the decision of the college.
Solemnly affirmed.
Signature of the Candidate
At (place) ____________________________ (Before me)
This (date) ________________day of_______________
The Signature affixed in my presence.
Place:
Date :
Notary Public
Address_________________________

_________________________________

_________________________________

Seal:
___________________________________________________________________________
*delete which is not applicable.

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