SWORN BEFORE THE NOTARY PUBLIC, M.

RAMPUR,
KALAHANDI
AFFIDAVIT

I Sri KISHOR KUMAR MISHRA, aged about 26 years, S/O BALARAM KUMAR MISHRA,
a resident of Village: SARGULMLPADA, P.S: M.RAMPUR, in the district of Kalahandi,
Odisha, do hereby solemnly affirm and state as follows :

1. That I am the deponent of this affidavit.

2. That I was having a smartphone of SAMSUNG J6 model having a AIRTEL PRE-PAID

MOBILE SIM No: +91 76810 32525, issued by the Deptt. of Telecom, Kalahandi Division,
Bhawanipatna, in my favour.

3. That the SIM issued in my favour which has been lost somewhere, while I was returning
home in my bike from Village: Karlamunda, under P.s: M.Rampur, on dated 28/09/2020 and
after my all efforts, it could not trace out.

4. That the said SIM is now very essential to me, for the purpose of use and references.

5. Hence, I swear this affidavit, so as to submit before the Inspector-in-Charge, M.Rampur

concern to make a Diary Entry in M.Rampur Police Station.

DEPONENT

VERIFICATION : Contents made in this affidavit, are true and correct to the best of my
knowledge and belief. Hence, I put my hand on this 28th day of September, 2020.

DEPONENT
 SWORN BEFORE THE EXECUTIVE MAGISTRATE,
M.RAMPUR, KALAHANDI
AFFIDAVIT

I Sri KISHOR KUMAR MISHRA, aged about 26 years, S/O BALARAM KUMAR MISHRA,
a resident of Village: M.RAMPUR, P.S: M.RAMPUR, in the district of Kalahandi, Odisha, do
hereby solemnly affirm and state as follows :

1. That I am the deponent of this affidavit.

2. That I have passed the Annual Higher Secondary Examination held in the month of
March, 2019 bearing Roll No:339MZ045 through Durga Madhav Uchha Vidyapitha,
M.Rampur.

3. That the Original Matriculation Certificate was issued to me by Board of Secondary

Education, Odisha has been lost somewhere, while I was returning home in my bike from M.R.
College, M.Rampur, under P.s: M.Rampur, on dated 28/09/2020 and in spite of my best effort, I
am unable to trace it out and it is beyond recovery. In case it is traced out in future, I shall submit
it to the Board of Secondary Education, Odisha for Cancellation.

4. That I am in need of duplicate copy of the said certificate for which purpose I hereby
make with the declaration as required by the Secretary, Board of Secondary Education, Odisha.

5. Hence, I swear this affidavit, so as to submit take admission in Sambalpur University for
Higher Study.

DEPONENT

VERIFICATION : Contents made in this affidavit, are true and correct to the best of my
knowledge and belief. Hence, I put my hand on this 28th day of September, 2020.

DEPONENT