This document is an affidavit for a duplicate leaving certificate. It states that the applicant passed higher secondary school in 1980-81 from Shri Damubhai Shukla Higher Secondary School in Ahmedabad. He was born in 1963 in Devagadh Baria and is Hindu. He lost his original leaving certificate and requires a duplicate for a passport application. He agrees to return the original if found and indemnify the school against any future claims.

1. AFFIDAVIT FOR DUPLICATE LEAVING CERTIFICATE
I, Ila Kanaiyalal Mehta, an adult, Indian Inhabitant, residing at xYZ>>>>Mumbai-40XXX,do hereby
solemnly affirm as under
1) That I have passed Higher Secondary School Examination through Shri Damubhai Shukla Higher
Secondary School,Paladi,Ahmedabad-380007,in the year 1980-81.My date of birth is 12th
December,1963 and was born at Devagadh Baria. I belong to Hindu Kapol Vaniya caste.
2) I say that I was issued the Original School / College Leaving Certificate by the School / College
authorities, but the same is either lost or misplaced and the same is not traceable in spite of my
all efforts.
3) I say that I require the duplicate school / college leaving certificate from the school / college
authorities for passport application purpose.
4) I request the school / college authorities to issue me a duplicate leaving certificate in lieu of my
Original lost certificate.
5) I agree and undertake to return the original school / college leaving certificate if I happen to find
the same in future and also undertake to keep the school / college authorities indemnified from
and against any loss,claims etc., if occurred in future.
I further wish to state that whatever is stated hereinabove is true and correct to the best of my
knowledge and belief.
Solemnly affirmed at Mumbai,
On this…………….. day of …………………
Signature of the applicant
Before me Signature of the Advocate