DUPL - AFFID
AMRITA VISHWA VIDYAPEETHAM, Coimbatore – 641 112
AFFIDAVIT TO BE FILED FOR ISSUE OF DUPLICATE CERTIFICATE
Affidavit of Thiru / Selvi _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1. I _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Son / Daughter of
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ aged _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Years,
an old student / student of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Degree of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
college with Register number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and residing at _ _ _ _ _ _ _ _ _ _ _ _
_____________________________________________________.
do hereby solemnly and sincerely state as follows.
2. My (i) * Statement of Grades / Marks issued relating to the Examinations held during _ _ _ _ _ _ _
(ii) * Degree certificate issued at the Convocation held on _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(iii) * Provisional Certificate / Consolidated Statement of Grades / Marks
issued by the AMRITA VISHWA VIDYAPEETHAM has irrevocably been lost / destroyed.
3. I file this affidavit for the purpose of receiving duplicate certificate.
4. I will return immediately the duplicate certificate(s) to the AMRITA VISHWA
VIDYAPEETHAM 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
AMRITA VISHWA VIDYAPEETHAM, I shall abide by the decision of the University.
Place :
Date : Signature of the Candidate
Solemnly affirmed
At _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (place)
This _ _ _ _ _ _ _ _ _day of _ _ _ _ _ _ 200 _ _ _
And his / her signature is affixed in my presence. Notary Public(Pass Out Studets)/
Principal(regular Students)
Address :
Office Seal :
*delete which is not applicable
