Lost Locker Key Declaration

Date:
To (Principal/Headmaster):
School Name:
Student Details
Name:
Class/Grade:
Section:
Roll Number:
Declaration
I hereby declare that I have lost my locker key assigned to me by the school. I have searched thoroughly, but have been unable to locate it. I request the school authority for assistance in this matter and am willing to bear any applicable charges or follow the procedure for a replacement key as advised.
Locker Number:
Details of Loss (optional):
Student Signature
Date:
Parent/Guardian Signature
Date: