Executed on non-judicial stamp paper of Rs. 100/- (value as required by the authority concerned)

AFFIDAVIT FOR LOSS OF DOCUMENT

I, Ramesh Kumar Sharma, son of Mohan Lal Sharma, aged about 35 years, a citizen of India, residing at House no., street, area, city, state - PIN (holding Aadhaar no. XXXX XXXX 4821), do hereby solemnly affirm and state on oath as under:

1.  That I am a major, of sound mind and fully competent to swear this affidavit, and I am the deponent in this matter. I have personal knowledge of the facts stated below, unless I have said that a statement is based on a document or on information.

2.  That I was the holder of the original Class 10 marksheet (Roll No. 123456), issued in my name, which I used to keep with me / in safe custody at my residence.

3.  That the said document was lost / misplaced on 15 August 2026, while travelling by bus, and I discovered the loss soon afterwards.

4.  That I searched for it at every place where it could possibly be, including my house, office, vehicle and the places I visited, and I asked the people who might have found it, but it could not be traced.

5.  That the loss was reported to the police: Lost report No. 45/2026. A copy of the report is attached, and I have also given notice of the loss in a local newspaper where it was required.

6.  That the said document has not been pledged, mortgaged, sold, gifted or handed over to any person, bank or institution, and no loan or other benefit is outstanding on the strength of the said document.

7.  That if the original document is found later, I shall at once surrender it to the issuing authority and shall not use it, and I shall use only the duplicate or certified copy issued to me.

8.  That I request the issuing authority to issue a duplicate / certified copy of the Class 10 marksheet after satisfying itself about the loss, and I undertake to pay the fee prescribed for it.

9.  That I have not concealed any material fact and no part of this affidavit is false. I understand that making a false statement on oath, or using a false affidavit before an authority, is an offence and can lead to penal action and to cancellation of any benefit obtained on its basis.

10.  That I shall produce the original documents referred to in this affidavit for inspection whenever the concerned authority asks for them, and I shall inform the authority at once if any fact stated here changes.

11.  That this affidavit is made in good faith for obtaining a duplicate of the Class 10 marksheet and for no other purpose, and I request the authority to accept it as true.

VERIFICATION

Verified at City on 14/11/2026 that the contents of this affidavit are true and correct to the best of my knowledge and belief, that nothing material has been concealed therefrom and that no part of it is false.

DEPONENT
Ramesh Kumar Sharma