Anna University - Online Services - Declaration form for Issue of Duplicate Certificate

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 Anna University - Duplicate Certifiate

DECLARATION TO BE FILED FOR ISSUE OF DUPLICATE CERTIFICATE

 

Declaration of Thiru / Selvi……………………………………………………………………………………

 

1. I…………………………………………………………………………………..…….         Son     /     Daughter     of

………………………………………………………………………………….aged…........................................ Years,

an old student / student of… …………………………. Degree of ………………………………………..

college with Register number…………………………………and residing at…………………………….

……..………………………………………………………………………………………………………………... do hereby solemnly and sincerely state as follows.

2.    My   (i)* Statement of Marks / Grade Sheet issued relating to the Examinations held during ……..…

(ii)* Degree Certificate issued at the Convocation held on…………………………………

(iii)* Provisional Certificate / Consolidated Statement of Marks / Grades issued by the Anna University has irrevocably been lost / destroyed.

3.    I file this declaration for the purpose of receiving duplicate certificate.

 

4.    I will return immediately the duplicate certificate(s) to the University once my original certificate(s) is / are recovered later.

5.    The facts stated are true and correct to the best of my knowledge and if found false by the University, I shall abide by the decision of the University.

 

Place :

Date :                                                                                                                     SIGNATURE OF THE CANDIDATE

Witness (1)          Name         :                                                               

 

Signature :                                                               

 

Address :                                                                

 

 

 

 

Witness (2)          Name         :                                                               

 

Signature :                                                               

 

Address :