AFFIDAVIT

I, Shaheen Shaikh spouse of Late.Shashavali Hussain Nabi Shaikh aged 45 Years,

residing at I/529 Near CSI Church Township, Dandeli – 581325, do hereby solemnly affirm and
declare as under:

1. That my name earlier was Riazulissa Shaikh.

2. That I have changed my name as Shaheen on/from 13/5/1992 at the time of getting
Married.

3. At present all the records have my new name Shaheen Shashavali Shaikh

4. I have not published in the Gazette for change of name.

5. I state that Riazulissa Shaikh and the Shaheen Shashavali Shaikh is the name of one
and the same person and that is myself.

6. I’m whole & sole responsible for all the Financial Claims done on my Husband’s name, if
any issues arising further, Second party won’t be held responsible for any claims or issues.

I am executing this declaration to be submitted to the concerned authorities for the change of
name. I hereby state that whatever is stated herein above are true to the best of my knowledge.

Solemnly affirmed at
On this 7th day of November 2020
(Signature of the Applicant)
Deponent

Identified by me Before Me

Advocate Notary Public