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    Application Form for Name Change

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    247 views4 pages

    Application Form For Name Change

    Uploaded by

    VarunPatyal
    application

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 4
    Form No. G—625 Serial No... {to be lait blank) BOARD OF SCHOOL EDUCATION, HIMACHAL PRADESH FORM OF APPLICATION FOR CHANGE IN NAME. . ‘The applicant should carsfally toad the rules given on pag: 4 and comply with same before filling in the form. Utmost careshould be caken to Write correct spelling of name according to the Board certificates. 2, The applicant should sign the appli tion as also the affidavit with old nome. DECLARATION TO BE SUBMITTED BY THE APPLICANT 1 (Old name). Som/daughter Of... -seseeceeeeesseee 7 Regd. No. (if any)... + -do hereby solemnly declare that subject to the sanction of ‘the Board, [have changed the name from....... me and that Tam ami it rate/Oat bef Maistrate/Oath Commissioner by my parents guardian. Jame major and an affidavit duly sworn before the Magistrate/Oath Commissioner by myself is enclosed herewith, The necessary fee of Rs is bing remitted as under:~ (a) By postal o>do:(3)/Bank Draft which is/are also enclosed herewith No.(6) of Postal ord-u(s)/Bank Draft and its/their value. @ : See ee ete age Bits ii (4)) Redicaicis an Pe aoa aAEC i (Postal Orders Bank Draft should be drawn in favour of the Secretary; Board of School Education, Himachal Pradesh, Dharamshala); (8) Board receip: No an a +» (iffee has been acknowledged by the office) ‘The particulars of the examination taken and being taken by me are as under — Name of Examination Month and Year of Exam. Roll No. Result Pass/Feailed, or saree cesses Pass/Failed, 2 aga S Pass/Failed 4 > Pass/Failed 5. Pass/Failed. 6 ape geniodvie A E che Pess/Failed The following certificates in original are sent herewith : 1 . et Ke a Ais a 5 ads ; ete ee ‘i The cutting from the newspaper in which I have notified the change in my name is pasted below Name of the Newspaper ‘SPACE FOR PASTING THE & CUTTING FROM THE Place of Publication ‘NEWSPAPER __} Date oF Publication (Spelling of the proposed change pore rreceiee Soules oe im name should be according to (Gignaiuce of te applicant with the old raime) advertisement). [ Compe cttie | Drapes t (Fo be filled in by Board Ofice) The applicant has completed all the formalities regerding >) Final order change in nameunder ths rules Particulars regarding examresu of the applicant have boon verified. "The nameof the applicant ix j Change in name as recommended tho Board record will now be as.. 3 : is allowed, aliasjnce. ... Clerk, Supdt., Scc:ion Officer Assistant Sceretary, SECRETARY Sr. Assistant 7.0.) Declaration im the case of those who did not join School afiiaed to this Board. but siucied paiva. Deehifation NO. 1. Lev. sear - reno -xgon Mapghtencofc “ i haraaels do hereby solemnly declare that I. did not.join: any ‘school/educational institution aflitted to the Board of Schoo! Education, Himachal Pradesh, Doramshats os ap ‘the Universiry of the Himachal Pradesh, ‘Shimla, but studied privately. *Signature. wk Bee! (of attesting authority) © Signature of sppi Designation Dated. (Oficial Stamp) Certificate by the Head of the Department Endst, No. Dated Certifiente No.—Forwarded to the Secretary, Board of School Education, Himachal Prades, Diaramtshala for necessary action with following remarks? (a), The office has no objection to this change. (©) The-applicent is employed in this office since............. (©) The entries made overleaf hove been verified, and found correct. Signature... Designation. (Official Stamp) Note.—The certificate is requited from the candidates who are in servic ‘of any School) College affiliated to Himachal Pradesh U' Himachal Pradesh, Diviramshala, Such candidates. sh ofthe Department where they are employed Certificate by the Head of the affliated Institutio: Dharam-hals being attended or last attended! #¢ bUL have never remained on the rolls ‘niversity or to the Board of School Education jould submit their application through the Head ‘vith Board of Schoo! Education, Himachal! Pradesh, Endst, No. Dated, Certificate No, 2. Forwarded to the Secretary, Board of School Education, Himachal Pradesh, Dharamshata for necessary action with the following remarks (@) The office has no objection to this change (6) The candidate is/was a student of .class of this school in the (@)- The entries made o¥erleat have been verified and found correct Signature Designation. (Ollicial Stamp) *Auestation of the following persons will only be acceptable, 1) Gazetted Officor, (2) | First Class Magistiate, (3) Headmaster/Principci of a affiliated school of thir Board, (4) An Officer of the Board not bolaw the reah of Deputy Secretary. 4 No. | (SPECIMEN) FORM OF AFFIDAVIT IN THE CASE OF MINOR APPLICANTS: (Applicant should write‘and sign hisyher dld aamiin the affidavit concerned) be son/daughter of. . do hereby solemnly declare that my ete ised is below eighteen years and tas cana hes ‘name from, ....... to. rays) with my consent and that he/she is one and the same person Signature... Depoiitat (Magistrate/Oath Commissioner) (Father/Guardian) Address, Place. ts (Oficial Stamp), Dated. 3 No. 2 (SPECIMEN) FORM OF AFFIDAVIT IN THE CASE OF MAJOR APPLICANTS T (old name) : " citation Soajdatighter of... do hereby solemnly declare that Lam a major (over eightsea years) and hav Ghanged my mane from. te, fandithat-Lanfonevand tecsianS pid Signature cow pares (Magisrace/Oath Comm*siones) (Applicant) Raion Place : (Ottcia! Stamp) Dated. i No. 3 (SPECIMEN, FORM OF AFFIDAVIT IN THE CASE OF WOMEN APPLICANTS WHO ARE MARRIED 1, (old namie) ae : daughier of Sh

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