Somaiya Vidyavihar University

Name of the College: K. J. Somaiya College of Engineering

PROFORMA I: GAP CERTIFICATE

On stamp paper of Rs. 100/-

AFFIDAVIT

I, Mr./Ms.___________________, aged ___ years, Indian Inhabitant, residing at

___________________________________ (residential address), do hereby state and declare
on solemn affirmation as under:-

I say that I have passed my ________________ (H.S.C or equivalent examination) exam in

________ (month & year of passing) through ____________________ (name of the Institute
with address and Board).

I further say that since ______ (year of passing of H.S.C or equivalent examination) till date I
did not join any educational Institute. I say that from ________ to 2022 is my Gap period.

I am making this Affidavit to produce the same before the concerned college authorities to
indicate my Gap period from ______to 2022 and pursue my studies for the B.Tech program
from academic year 2023-24 at K. J. Somaiya College of Engineering (A Constituent College
of Somaiya Vidyavihar University).

Whatever stated hereinabove is true and correct.

Solemnly affirmed at Mumbai on )

___ day of _____ 2022)

Identified by me DEPONENT.

BEFORE ME Advocate