Application For Change Of Name (Page 3 of 3) in pdf

Application For Change Of Name Page 3

AFFIDAVIT

_____________________S/o,D/o,W/o

___________________________age

__________years, R/o H.No.__________, Locality_______________mandal,

_______________district do hereby solemnly affirm and state on oath as follows:

I am resident of _____________District since _____________years. My original name

is ________________________ and I intend to change my name /My children’s name

(strike off whichever is not applicable) as __________________________________

For the following reasons ________________________________________________

In this regard, I state that I have not made any changes to my name / my children’s name,

that I am not involved in any litigation Civil or Criminal cases. To prove the same I

enclose herewith a certificate of my character and antecedents duly obtained from the

concerned police station .

The above facts are true and correct to the best of my knowledge and belief and that in

any event my above statement is proved to be false, I will be held responsible for the

same and action may be taken against me U/s 199 and 200 of the Indian Penal Code.

DEPONENT

Sworn and signed before me on this

………..day of ……..month ………

year at ………..place.

NOTARY

Application For Change Of Name Page 3