AFFIDAVIT

I,…………………………………………aged…………,S/o/D/o………………………………….,residing
at…………………………………………………………………………………………………......……………
………………………... do hereby solemnly affirm and state as follows.
Now I am residing at ……………………………………………………………………………………………….
…………………………………..……… I have completed my ……………….Course from National Institute of
Technology Calicut in the year ………….. . My ……….. *Semester grade card/Consolidated Grade Card/Degree
Certificate/Provisional Certificate/TC/Migration/………………….. with Roll No…………………. has been lost
irrecoverably from my possession. I published the matter in ……………………………………….dated
…………………. . But all efforts to trace out the same is miserably failed.
Now I want to apply for a duplicate copy of the same. In case I find out the same in future, I will surrender it
before the authorities without fail. I will never misuse it.
This affidavit is to produce before the National Institute of Technology Calicut authorities along with my
application to obtain a duplicate copy as stated above.
I have not concealed or misrepresented any fact.
The above facts are true.

Dated ………………………………..

Deponent
The Literate deponent solemnly
affirmed and Signed before me at
Calicut on …………….

Signature and Seal of the Notary

*Delete whichever is not applicable.