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18 views

Format Affidavit

Uploaded by

faris babu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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KERALA UNIVERSITY OF HEALTH SCIENCES

THRISSUR - 680 596


PHONE: 0487 - 2207650, 2207664 & 2207642

AFFIDAVIT

I,......................................................... (Name), aged ....................(Years), D/o or S/o.......................................... residing at


Document 2023/6863/1 - General - File No. 2023/2715/1

...............................................................................................................................(Permanent Address) solemnly affirm and


swear as follows:

1. That I am/was a student of .................................................................(Name of Course) at .....................................


Approved by CE on 02/02/2023 11:05:47

.......................(Name of College) during the acamic year.......................(Period of Study), affiliated to Kerala


University of Health Sciences,Thrissur.
2. That I have appeared for the .............................................................(Name, Month & Year of examination of
which Mark List/Degree certificate lost or damaged) with Register No.....................and obtained the Mark lists/
Degree of the aforesaid examination (If known, mention the folio no.) from the Kerala University of Health
Sciences,Thrissur.
3. That the original of the above Mark List/Degree has/have been irrecoverably lost/damaged .........................
(Specify the reason for loss or damage)
4. That I have made all efforts to trace out the same, but ended in vain. And, I have published the matter on loss of
the above marklists/certificate in the .................................... (Name of Daily) on ............(Date of Publication)
5. That this affidafit is issued only after 15 days from the date of newspaper notification.
6. That I have not misused the said Mark list/Degree for any purpose and will not spoil the same and nobody will
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be allowed to do so.
http://www.kuhs.ac.in

7. That the original of the ..............................................................(Name of examination of which Mark List/Degree


certificate lost or damaged) with Register No.....................would be surrendered to the University if it is
recovered hereafter.
8. This affidavit is furnished before the Controller of Examinations, Kerala University of Health Sciences,Thrissur
for obtaining duplicate Mark list/Degree................................................................ (Name of Examination) with
Register No.............

All those facts stated above are true and correct to the best of my knowledge and self belief.

Dated this the ..........day of............................................(Month & Year)

Deponent: ..................................................................(Name of the candidate with signature)


KUHS,Thrissur

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