CHANGE OF NAME AFFIDAVIT

I SHRUTHI (VARALAKSHMI) w/o MUNIRAM R aged about 23 years

Residing at No. 373/3 Main Road, Billa kempanahalli, via Bidadi,
Ramnagar Tq. Bengaluru 562109 do here by solemnly affirm and declare
as under;

(1)That my name has been recorded as VARALAKSHMI in all the

certificate and relevant document etc..
(2)That in My sons Birth Certificate has been recorded as SHRUTHI and
I would like to change my name From SHRUTHI to VARALAKSHMI.
(3)So that now I declared through this wide affidavit that SHRUTHI and
VARALAKSHMI both names are called the same person and its me.
(4)That in future I will known by my original name i.e., VARALASHMI in
future for all purposes.

WHEREFORE that the contents of Para no. 01 to 04 are correct my

knowledge and belief. Nothing has been concealed therein.

PLACE: BENGALURU
DATE:
VERIFIED BY ME:

DEPONENT