In the application for issue of duplicate licence

Before the deputy chief controller of exports, department of supply, ministry of road, new delhi. In the matter of issue of duplicate licence.
Affidavit of A, aged about _____________ years, son of B, resident of __________________.
I, the deponent above-named, do hereby solemnly declare as under: –
1. That licence No. )___________ dated ______________ issued to me for export of metal goods has been lost.
2. That the said licence has not exhausted at all.
3. That the total quantity for which the licence was originally issued was ________________ and the quantity so far exported is to the extent of ____________.
4. That the duplicate copy is now required to cover the quantity.
5. That the original licence will be returned to the licencing authority for cancellation, if and when found, without being utilised at all.
DEPONENT
I, the above-named deponent, declare and verify that the contents of paras 1 to 5 are true to my personal knowledge and nothing has been concealed and no part of it is false.
DEPONENT