AFFIDAVIT

I, Rathnamma.C, Aged about 40 years, D/o Channaiah, Residing at No. 386,

6th Cross, 8th Main, Hampinagar [RPC Lay-out], Vijaynagar 2nd Stage,
Bangalore – 560 0104 do hereby solemnly affirm and state on oath as
follows:-
1. I declare and submit that I am residing in the above said address and I
am the permanent resident of Bangalore City.

2. I declare and submit that in my school records my name is mentioned

as C.Rathnamma but in my PAN card, AADHAAR Card and other
documents my name is mentioned as Nagarathnamma.C

3. I declare and submit that my above said names are one and the same.
I have made this affidavit to produce before the Life Insurance
Corporation to consider my above said names are one and the same.

This is my name and signature and the contents of this affidavit are true
and correct to the best of my knowledge, information and belief.

Identified by me, DEPONENT,

SWORN TO BEFORE ME
Advocate,
Bangalore,
Dated: 02.05.2017.