To be typed on 100 rupees’ stamp paper and should be notarised

AFFIDAVIT

I, _________________________________________________ aged about _______ years,

S/o,/D/o, ________________________________________________, residing at
__________________________________________________________________________,
do hereby solemnly affirm and state an oath as follows:

I state that I have lost my Acknowledgement Slip issued by Presidency University for having
submitted my Original Marks Cards to Presidency University for verification and the same
could not be traced. Hence, I request the concerned authority to return my Original Marks
Cards in the absence of production of the above mentioned acknowledgement slip.

I hereby undertake to keep the Presidency University, indemnified and harmless from and
against any future claims, losses and damages, costs, Charges etc., which may arise due to
return of my Original Marks Cards in the absence of Acknowledgement Slip.

IN WITNESS WHEREOF, I have signed this at Bangalore, on this __________ day of ________
2022.

Witness: -

1. DEPONENT

(Notary Public)