AFFIDAVIT

I, ———————–S/o———————/Daughter of ——————-, aged …. YEARS,

Indian Inhabitant, resident of ——————–, do hereby solemnly affirm and declare as under:
1.That my name as per the records is —————-(XYZ).
2.That I have changed my name as _________ on (date of change of name) by giving the
intimation in gazette. .
3. At present all the records have my new name _________.
4. I am getting a public notice published to this effect in the newspaper.
5. I state that (earlier name) and the (present name) is the name of one and the same person and
that is myself.
6.I am executing this affidavit to be submitted to the concerned authorities for the change of
name.
7. I hereby state that whatever is stated herein above are true to the best of my knowledge.

Solemnly affirmed at ________ )

On this ____ day of ______ 20 )

…(Sign.)
Deponent