Affidavit for Duplicate Documents
In
The Court of Executive Magistrate …………………………… (District), Bihar
AFFIDAVIT
I, ……………………………………………. (Full Name of the Applicant), Son of
…………………….…………… (Father’s Full Name) & / or ……………………………
(Mother’s Full Name) and presently residing at Village: …………………………..., Post
Office…………..., Police Station: …………………….…, District: ……………, Pin Code:
…………… (Bihar) do hereby solemnly affirm and declare as under:
1. That, I am a citizen of India.
2. That, I have passed the ……………………….. (Secondary / Intermediate / Other)
Examination, Conducted by ………………………. (BSEB / erstwhile BIEC) from
………………………………………… (Name of School / College/ Institute),
bearing Roll code: ……………, Roll No …………………, in the year ………. and
Faculty ………….…….. (as applicable).
3. That, I require duplicate document (s) ............................................................... .........
(mention name of duplicate document(s) as original document(s) has / have been
............................................................................ (mention reasons: burnt in fire /
destroyed by termite / lost / stolen / others).
4. That, I undertake to submit self-attested photocopies of required document for the
aforesaid duplicate document(s) and will produce original(s) for verification.
5. That, all statements of this affidavit are true and correct to the best of my
knowledge and belief as explained to me and understood. If found untrue and false,
I will be personally liable to be punished in accordance with law.
Place: ...................................
Date: ................................... Signature of Deponent
I certify the signature of the Deponent who has signed before me.
Signature of Advocate
BCI Enrolment No........... / ........
AOR No.................
