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Name Change

S. Asemulla, an Indian Hindu, formally renounces the name D. Sarojamma and adopts the name K. Sarojamma, while also assuming the surname Kavali. He declares that he will use the name Derangula Lakshmi Naveena in all records and transactions, and acknowledges that this name change is not intended to deceive. The affidavit is signed and dated June 29, 2012, confirming the truth of the statements made.

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uday kiran
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46 views3 pages

Name Change

S. Asemulla, an Indian Hindu, formally renounces the name D. Sarojamma and adopts the name K. Sarojamma, while also assuming the surname Kavali. He declares that he will use the name Derangula Lakshmi Naveena in all records and transactions, and acknowledges that this name change is not intended to deceive. The affidavit is signed and dated June 29, 2012, confirming the truth of the statements made.

Uploaded by

uday kiran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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AFFIDAVIT

By this I the undersigned [Link] S/O [Link] aged about 33 years, Indian Hindu residing
at [Link]: Lingapuram village, Muthukur post, Peddapanjani Mandal, Chittoor District, A.P. do hereby
solemnly affirm and state as follows:

1. That for and on behalf of myself and my parents and remoter issue wholly renounce, relinquish
and abandon the use of my former name of [Link] (only) and in place and thereof do
assume from the date here to the name of ( NEW INTIAL) [Link] INSTEDE of initial ‘B’
and so that myself and my parents issue may hereafter the called known and distinguished not
be by former name/surname KAVALI But by my assumed name/surname(NEW INTIAL) KAVALI
SAROJAMMA
2. That for the purpose of the evidence such my determination declare that sell at all times
hereafter in all records, deeds and writings and in all proceedings, dealings and transactions as
well as private publish and up on all occasions what so ever use and sighed by name of
DERANGULA LAKSHMI NAVEENA as my name/surname in place of and in sub stations for my
former name by surname of DERANGULA LAKSHMI NAVEENA
That I expressly authorise and request all persons in general relatives and friends in particular at all
times hereafter to designate and address myself and my parents issued by such assumed name of
DERANGULA LAKSHMI NAVEENA accordingly.

3. That I hereby acknowledge and indemnify on acts, deeds and liabilities by me as DERANGULA
NARASAMMA (old name) and known to all men, I declare that change of name is not to call any
prejudice and not with any fraudulent intention.
4. In witness whereof I have hereinto subscribed my former and adopted names of DERANGULA
NARASAMMA and DERANGULA LAKSHMI NAVEENA and affixed my seal with this 29 TH day of
June, 2012 at M VADDI PALLI.
5. The above facts are all true and correct to the best of my knowledge and belief.

WITNESSES Signature with Original Name.


Signature with Assumed Name.

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