Prapti Parekh- B033

SPECIMEN AFFIDAVIT FOR CHANGE IN NAME

(On non-judicial stamp paper of minimum value)

I Mr. Piyush Singh S/o Vijaykumar Singh aged about 25 years, resided at Gulmohar road, Juhu,
Mumbai. Do hereby solemnly affirm and sate a follows:

1. That my recorded name in school and college is Piyush Singh (YOURNAME), but I myself
popularly known as Pratik Singh. (New name).

2. That by virtue of this affidavit, I changed my name from Piyush Singh to Pratik Singh and
henceforth I shall be known as the Pratik Singh for all purposes.

3. 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, dealings and transactions,
private as well as upon all occasions whatsoever, use and sign the name of Pratik Singh as my
name/surname in place and in substitution of my former name/surname.

4. That the facts stated above are true to the best of my knowledge and belief.

5. In witness whereof I have hereunto subscribed my former and adopted name/surname of

Piyush Singh and Pratik Singh affix my signature and seal, if any, this 20th day of March

Signed sealed and delivered by the above name

Date – 20th March 2024

Former name - Piyush Singh

In the presence of:

Name – Shankar Menon Name – Eishan Patel

Address - Borivali, Mumbai Address – Goregaon, Mumbai

(This affidavit may be signed and attested in presence of a Judicial Magistrate or Executive
Magistrate/Notary Public or Consular Officer in an Indian Mission abroad)

Note: In case of change of name, applicant should insert advertisements in two reputed
newspapers (one local newspaper of the area in which he/she is residing and 2nd in newspaper of
the area of permanent address) and submit original newspapers at the time of applying to
Institute.