ON A RS. 20/- (IF NOT AVAILABLE THAN ON RS. 100/- OR RS. 50/- STAMP PAPER
I, ____________________, _______________ years of age, residing _____________________.
________________________________________, hereby solemnly affirm that that the original receipt for a payment of Rs ________________/- ( Rupees _____________________________) made in favour of NIFT, Mumbai on _____________________ towards tution fees for my daughter, ________________________, who is a student of the __________________course at NIFT, Mumbai, has been lost.
Further I undertake that once the refund money is received, I shall not make any further claim from NIFT, Mumbai, in the event of the original receipt being found on a later date.
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Name and Signature of the student alongwith with the residential address and pin code.