Statutory declaration

I, the undersigned …………………………………………………………………… (name and surname)

born on ……………………………………………………………..…………………………. (date of birth)

permanent address ……………………………………………………… (place of permanent residence),

hereby declare that the copy of the document

……………………………………………..………………………………………………………………………,

which I use to evidence my previous education under Section 48 of Act No. 111/1998 Coll. on Higher
Education Institutions, as amended, corresponds to the original.

I am aware that forgery of public documents (certificates, diplomas) is a crime under Section 348
of Act No. 40/2009 Coll. Penal Code; under Section 67 of Act No. 111/1998 Coll., on Higher
Education Institutions, the student who was admitted as a result of fraud shall be expelled from
studies.


In…………………………………..……….. on…………………. 2021


……………………………………………………………

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