PROFORMA - I by lonyoo

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									PROFORMA - I
(This Proforma is intended for the Change of Name only) Please read the instructions on the reverse side of this Proforma carefully and fill up the particulars in the BOXES IN ENGLISH (BLOCK LETTERS ONLY) From: Thiru / Selvi / Thirumathi *Use one box for one alphabet only *Leave one box blank after each word *Do not split the word *Use next line

I, (Old Name) Initial Son / Daughter / Wife of Thiru Born on
Date Month Year

My Son / Daughter [For Minor]*

Age Male / Female

Native District :

Residing at : Door No. Old : New :

PIN Code Number

Shall henceforth be known as (NEW NAME IN BLOCK LETTERS)

Station : Date :

(i) Signature............................................................. (As in the column of Old Name) (ii) *Signature of Parent or Guardian (if parents deceased) in the case of minors with relationship in BLOCK LETTERS.

Reason for the Change of Name :........................................................................................................................................... (i) (ii) I hereby declare that I am a native of Tamil Nadu and residing permanently in Tamil Nadu. To prove the nativity, Duly certified copy of the certificate issued by the Tahsildar (or) Xerox copy of Ration Card should be enclosed.

(i)

Signature................................................................... (As in the column of Old Name)

(ii) *Signature of Parent or Guardian (if parents deceased) in the case of minors with relationship in BLOCK LETTERS. WITNESS The information furnished above are correct and true to the best of my knowledge and belief. ...................................................................... Name of the Witness in BLOCK LETTERS Status / Occupation and Address........................................... ................................................................................................ FOR OFFICE USE ONLY Mode of Payment Cash / DD For Rs. R.V. No. : Receipt No. : R.V. Clerk. 281-4—20,000 Cps.—14-6-08 [P4-13d] Superintendent. [P.T.O. Date : C.P. Register No. ...................................................................... Signature of the Witness [The Witness should be an ‘A’ or ‘B’ Group Officers of Tamil Nadu State (or) Central Government with seal.]

To be Published in the Tamil Nadu Government Gazette.

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THIS PROFORMA IS INTENDED FOR THE CHANGE OF NAME ONLY If the change of name is due to the change of religion from one religion to another a separate PROFORMA-II is available and will be sent on application. INSTRUCTIONS FOR FILLING THE APPLICATION.
CONDITIONS: 1. Applicant alone should sign in the application (OLD NAME) 11. No correspondence will be entertained with any persons other than the applicant. In case of minor either parents or guardians (if Parents deceased) 12. Door No. & PIN Code should be written in the address without fail. should sign in the column provided. 13. Specify the Native District only. 2. One witness from an ‘A’ or ‘B’ Group Officers of Tamil Nadu State 14. Specify the punctuations in between Initials and Name accurately. Government/Notary Public or Central Government, not related to 15. Applicant should sign in old name only. the applicant should be obtained in the column provided. 16. For further details contact Assistant Director (P), Chennai-2 in 3. Notice for change of name will be entertained only in respect of Phone No. 2852 0038. persons who are native of this State for which they should give Enclosure: declaration in the column provided. I. No enclosure is necessary for those who are born in 4. The reason for change of name shall be furnished. Tamil Nadu and residing in Tamil Nadu. 5. Fees: Rs. 415 from 9-2-2004. II. Those who are born outside the State of Tamil Nadu and 6. Method of Payment : residing in Tamil Nadu duly certified copy of the Ration Card/Voter In person : Cash Identity/Residential Certificate issued by Tahsildar should be By Post : Demand Draft in favour of Assistant Director (P), enclosed. Commissionerate of Stationery and Printing, III. Change of Initial, name due to adoption: Chennai-600 002, drawn from a Nationalised Bank. Duly certified Copy of Registered Adoption Deed to be enclosed. 7. Working Hours: For Payment Signature of the Adopted father is necessary in the Morning : 10.00 a.m. to 1.00 p.m. application. Afternoon : 2.00 p.m. to 3.00 p.m. IV. Change of name due to divorce: (Except Government Holidays) Duly Certified Copy of Judgement to be enclosed. 8. Money Order/Indian Postal Order are not accepted. Five copies of Tamil Nadu Government Gazette will be sent to the Applicant in which his name change has been published by Registered 9. The application issued by this Department Alone will be accepted. Post. Additional Copies will have to be purchased from the Assistant Xerox copy will not be accepted. Director (P), Commissionerate of Stationery and Printing, 110, Anna 10. No reminder to the party either for remittance or any other Salai, Chennai-600 002 on payment of cost by means of D.D. or cash. particulars will be sent.


								
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