Sample name change form for legally changing your name

Some days ago, I changed my name. Changing name involves 3 steps (1) Affidavit (2) Newspaper Publication (3) Gazette Notification. Before Gazette Notification, you have to send a request letter to the Government requesting therein for allowing you for publication of notice in the official Gazette. In you letter to need to attach a NAME CHNAGE DEED FORM.  Below you can find a sample name change form.

Deed Changing Surname Form

By this deed I, the undersigned ……………………………. (New name ) If etc., now lately called ……………………………. (Old name ) employed as ……………………………. (Designation of the post held) at the time by the Government concerned at ……………………………. place where employed in the……………………….. (Department) of the Government of Orissa, do hereby.

1. For and on behalf of myself and my wife and children and remoter issue I wholly enounce relinquish and abandon the use of my former surname of…………………….. and in place thereof do assume from the date hereof the surname of………………………….. known and distinguished not by my former surname of ………………………………………………………… but by my assumed surname of …………………………………………….

2. For the purpose of evidencing such my determination I hereby declare that I shall at all time hereafter in all records, deeds and writings and in all proceeding, dealing and transaction private as well as public and upon all occasions whatsoever use and sign the name of……………………. as my surname in place of and in substitution of my former name of………………………………………………

3. I expressly authorise and request all persons at all times designate and address me and my wife and children and remoter issue by such assume surname of………………………………….. accordingly.

In witness of where I have hereunto subscribed by my former and adopted name of ……………………………. and affixed my seal this …………………. day of signed sealed, and deliver by the above name.

(New name formerly)                                             Old name………………………….

(Old name in the pursuance of)                            New name………………………….

Two Witnesses

1.

2.

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