PART A — APPLICATION FOR PUBLICATION OF CHANGE OF NAME IN THE GAZETTE OF INDIA
To
The Controller of Publications,
Department of Publication,
Government of India.
(Filed online at egazette.gov.in, or by post to the Department's office, whose current address that portal publishes.)
Subject: Application for publication of change of name in the Gazette of India
Sir/Madam,
I, __________, __________ __________, aged __________ years, resident of __________, Aadhaar No. __________, request that my change of name from __________ to __________ be published in the Gazette of India.
I enclose with this application:
(a) my affidavit affirming the change of name, sworn before a Notary Public / Oath Commissioner, set out at Part B below;
(b) proof of my identity and address in my present name;
(c) the newspaper cutting(s), or e-paper printout, of the advertisement of this change published as set out at Part C below;
(d) the fee prescribed by the Department, as applicable on the date of this application.
I request that the notification be published at the earliest.
Yours faithfully,
__________
Place: __________
Date: __________
PART B — ANNEXURE I: AFFIDAVIT
I, __________, __________ __________, aged __________ years, resident of __________, do hereby solemnly affirm and declare as under:
- That I have given up the name __________ and have adopted, and shall hereafter be known by, the name __________.
- That the reason for this change of name is __________.
- That __________ and __________ are one and the same person, that this change is made voluntarily and not for any fraudulent purpose, and that I undertake to use only the name __________ hereafter.
- That I have no objection to this change being published in the Gazette of India and in the newspapers named at Part C below.
VERIFICATION
Verified at __________ on __________ that the above is true and correct to the best of my knowledge and belief.
DEPONENT
__________
Signature: ______________________________
Sworn/Affirmed before me this __________ at __________.
NOTARY PUBLIC / OATH COMMISSIONER
Name: ______________________________
Registration No.: ______________________________
Seal and Signature: ______________________________
PART C — ANNEXURE II: TEXT FOR NEWSPAPER ADVERTISEMENT
PUBLIC NOTICE
I, __________, __________ __________, resident of __________, have changed my name to __________. All concerned please note.
To be published in: __________ and __________.