Specimen Affidavit For Change In Name

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SPECIMEN AFFIDAVIT FOR CHANGE IN NAME
(On non-judicial stamp paper of minimum value)
I Mr. ……………………….. S/o ………………………………… aged about ____________ yrs, resided
at………………………………. Do hereby solemnly affirm and sate a follows:
1. That my recorded name in school and college is ______________(YOURNAME), but I myself
popularly known as _________________(New name).
2. That by virtue of this affidavit, I changed my name from YOURNAME (old name) to
CHOSENNAME (new name) and henceforth I shall be known as the CHOSENNAME (new
name) 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
………………… 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
………….. snd ……… affix my signature and seal, if any, this ………………….. day of ………
Signed sealed and delivered by the above name
Date…………….
Former name……………
In the presence of:
Name………………..
Name ………………….
Address…………….
Address ………………..
(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.

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