(SPECIMEN OF AFFIDAVIT)

(To be submitted on Non-Judicial Stamp paper of Rs.20/- duly verified by Oath

Executive Magistrate)
IN THE COURT OF EXECUTIVE MAGISTRATE _______________
AFFIDAVIT
I,___________________Son/daughter/wife of_____________________resident
of ___________________________________________________________do
hereby solemnly affirm as under:1. That I have been admitted/ registered in the Deptt. of
_________________________, National Institute of Technology, Arunachal
Pradesh forB.Tech./M.Tech./Ph.D. programme on ________.
2. I am pursuing the said programme on whole time basis in the Department of
_______________________________since____________________
3. That I have not availed any fellowship/financial assistance so far for pursuing
thiscourse.
OR
That I have availed of fellowship/financial assistance from
___________@Rs._______w.e.f.________________to_____________
4. That if I violate the terms and conditions of the Scholarship, the Scholarship
sanctioned to me, may be cancelled and the entire amount of scholarship will
be refunded by me or recovered from me, apart from liability for such penal
action as warranted by law or Institute Authority and Ministry.
5. Incase of dispute, the decision of NIT, AP authority will be final and binding on
me.
DEPONENT
Verification
I, ________________ do hereby confirm or verify that the statements made above are
true to the best of my knowledge and belief.

DEPONENT
Executed before me on __________________ at ____________________

Identified by
Executive Magistrate
____________________