Loss of Certificate Affidavit

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Select State for Stamp Paper*

Andhra PradeshAssamDelhi/NCRGujaratHaryanaHimachal PradeshJammu & KashmirJharkhandKarnatakaLadakhMadhya PradeshMaharashtraPunjabRajasthanTamil NaduTelanganaUttarakhandUttar PradeshWest Bengal

Name*

RELATION*

Son ofDaughter ofWife of

Related Person Name*

Address*

Name of Loss Certificate/Document*

Name of Authority/School/College*

Receipt Number/Roll Number/Enrollment Number*

Other Information

Select Stamp Paper amount*

10 (commonly used for Delhi/Jharkhand/UP)20 (commonly used for Karnataka/Telangana/Tamil Nadu/WB)50100 (commonly used in Maharashtra)101 (commonly used in Haryana)

Price

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