FORM – 1A

AFFIDAVIT

I, ____________________________________ S/o D/o ____________________________________ aged

Student’s Name Father’s Name
_________ years, Resident of ____________________________________________________________
Residential Address
____________________________________________________________________ do hereby solemnly
affirm and status follows:
That I have passed _________________ Degree from___________________________________
College Name
____________________________________ in the year of ____________________ with Hall Ticket No.

______________________.

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 authorities for cancellation

The facts stated above are true and correct to the best of my knowledge and belief.

Solemnly affirm and signed before me.

DEPONENT