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AFFIDAVIT AND INDEMNITY BOND FOR A LOST ACADEMIC CERTIFICATE
PART A — AFFIDAVIT OF LOSS
I, __________, __________, resident of __________, do hereby solemnly affirm and declare as under:
That I was issued __________ bearing number __________, by __________, in the year __________.
That the said certificate has been lost under the following circumstances: __________
That despite the following efforts, the certificate could not be traced: __________
That __________
That __________
That the said certificate has not been pledged, deposited, mortgaged or transferred to any person or institution, and remains untraced despite the efforts stated above.
That this affidavit is sworn in support of an application for issuance of a duplicate certificate in place of the one lost.
That the contents of this affidavit are true and correct to my knowledge and belief, that no part of it is false and that nothing material has been concealed therefrom.
VERIFICATION
Verified at __________ on this __________ that the contents of paragraphs 1 to 9 above are true and correct to my knowledge, that no part of it is false and that nothing material has been concealed therefrom.
DEPONENT
_________________ __________
Sworn before __________ at __________ on __________.
PART B — INDEMNITY BOND
I, __________, __________, resident of __________, in consideration of __________ agreeing to issue a duplicate of __________ bearing number __________ in place of the original lost as stated in Part A above, do hereby undertake and bind myself as follows:
That I shall indemnify and keep indemnified __________ against any loss, claim, demand or liability that may arise out of, or in connection with, the issuance of the duplicate certificate, including any loss, claim or liability arising from misuse of the original by any person into whose hands it may come.
That if the original certificate is found, or comes into my possession or knowledge at any time hereafter, I shall immediately inform __________ in writing and surrender the original for cancellation.
That I shall be solely responsible for any consequence arising from any false statement made in Part A above.
IN WITNESS WHEREOF I have signed this indemnity bond at __________ on __________.
AFFIDAVIT AND INDEMNITY BOND FOR A LOST ACADEMIC CERTIFICATE
PART A — AFFIDAVIT OF LOSS
I, __________, __________, resident of __________, do hereby solemnly affirm and declare as under:
That I was issued __________ bearing number __________, by __________, in the year __________.
That the said certificate has been lost under the following circumstances: __________
That despite the following efforts, the certificate could not be traced: __________
That __________
That __________
That the said certificate has not been pledged, deposited, mortgaged or transferred to any person or institution, and remains untraced despite the efforts stated above.
That this affidavit is sworn in support of an application for issuance of a duplicate certificate in place of the one lost.
That the contents of this affidavit are true and correct to my knowledge and belief, that no part of it is false and that nothing material has been concealed therefrom.
VERIFICATION
Verified at __________ on this __________ that the contents of paragraphs 1 to 9 above are true and correct to my knowledge, that no part of it is false and that nothing material has been concealed therefrom.
DEPONENT
_________________ __________
Sworn before __________ at __________ on __________.
PART B — INDEMNITY BOND
I, __________, __________, resident of __________, in consideration of __________ agreeing to issue a duplicate of __________ bearing number __________ in place of the original lost as stated in Part A above, do hereby undertake and bind myself as follows:
That I shall indemnify and keep indemnified __________ against any loss, claim, demand or liability that may arise out of, or in connection with, the issuance of the duplicate certificate, including any loss, claim or liability arising from misuse of the original by any person into whose hands it may come.
That if the original certificate is found, or comes into my possession or knowledge at any time hereafter, I shall immediately inform __________ in writing and surrender the original for cancellation.
That I shall be solely responsible for any consequence arising from any false statement made in Part A above.
IN WITNESS WHEREOF I have signed this indemnity bond at __________ on __________.
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