To,

The Librarian,
National Institute of Technology,
Hamirpur (H.P.) – 177005

Subject : Loss of Identity cum Library Card.

Sir,

I hearby report the loss of identity cum Library Card

No…………………………………….Issued to me and request you for the duplicate Identity cum
Library Card. I agree to pay the necessary charges according to the rules. I am enclosing the affidavit
in this regard. Further, I hold myself responsible for any misuse of the library pass book which I am
reporting as lost.

Name……………………………………...

Class……………….Roll No……………..

Department………………………………

Dated ……………… Signature…………………………………

Allowed

Librarian Assistant Librarian

A sum of Rs. received vide receipt No…………………..………………………...

Dated :……………………………

Circulation Asstt.

The Duplicate card is prepared

Assistant Librarian Assistant

Librarian

Dean (Academic)