Form-1A
Form-1A
AFFIDAVIT
(For Duplicate Marks Memos / CMM)
(Printed on Rs.20/- Notary bond paper)
I,______________________________S/o/D/o _____________________________ aged_____ years
( Student’s Name) (Father’s Name)
Resident of ____________________________________________________________ ___________
(Residential Address)
____________________________________________________________________ do hereby solemnly
affirm and status follows:
That the Original _______________ certificate was sent to me by JNTUH, but I did not receive the
certificate(s). I am unable to track the said certificate(s) and it is lost beyond recovery.
I am in need of a duplicate ________________ certificate(s) for which purpose I am hereby making this
declaration as required by the concerned authorities.
I solemnly that, in case my original certificates(s) is / are traced out in future, I shall submit the same to
JNTUH, Hyderabad authorities for cancellation
The facts stated above are true and correct to the best of my knowledge and belief.
DEPONENT