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AFFIDAVIT FOR CHANGE IN NAME

By this deed , I the undersigned Harshita A Pandiyani (New Name), previously

called Prakashben A Pandiyani (Old Name), aged 26 years, and resident of

(Address)

[1] That for and on behalf of myself and my husband and remitter issue wholly

renounce / relinquish and abandon the use of my former name / surname of

Harshita A Pandiyani and in place of thereof I do assume from this date the

name / surname Prakashben A Pandiyani

[2] That for the purpose of evidencing such my determination declare that I shall

at all times hereafter in all records, deeds and writings and in all proceedings,

dealing and transactions, private as well as upon all occasions whatsoever use and

sign the name of Prakashben A Pandiyani as my name / surname in place and

in substitution of my former name / surname.

[3] That I expressly authorize and request all person in general and relatives and

friends in particular, at all times hereafter to designate and address me, my

husband, remitter issue by such assumed name / surname of Prakashben A

Pandiyani accordingly.

[4] In witness of I have here unto subscribed my former and adopted name /

surname of Harshita A Pandiyani and Prakashben A Pandiyani affix my

signature and seal, if any, this day - 2020

Date : / /2020 Signed sealed and

Place : delivered by the above name

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