PROFORMA -I ANNEXURE FORM OF THE DEED FOR CHANGE OF NAME BY THIS DEED: I the undersigned (A,B,C, New name) of etc, new lately called A.C. (Old name) employed as ...............(Designation of the post held at the time by the Government Servant concerned) at .............. (place where employed in the Department). 1. For and on behalf of myself and my wife and children and remoter issue wholly renounce, relinquish and abandon the use of my former surname of C (only) and in place thereof do assume from the date hereof the surname of B.C. and so that I and my former surname of C (only) but by my assumed surname of B.C. 2. For the purpose of evidence such my determination declare that shall at all times hereafter in all records deeds and writings and in all proceedings, dealings and transactions as well as private publish and upon all occasions whatsoever use and sign by name of B.C. as my surname in place of and in substitution for my former surname of C. (only). 3. Expressly authorise and request all persons at all times hereafter to designate and address me and my wife and children and remoter issue by such assumed surname of B.C. accordingly. 4. I hereby acknowledge and indeminify all acts, deeds and liabilities by me as (old name) and known to all men, I declare that change of name is not to cause any prejudice and not with any fraudulent intention. 5. IN WITNESS WHEREOF I have hereunto subscribed my former and adopted names of A.C. and A.B.C. and affixed my seal this ............................ Day of ...................... Signed, sealed and delivered A.C. Signature with original Surname. By the above name A.B.C. Formerly A.C. in the presence of (b) A,B,C, Signature with assumed Surname. WITNESS: 1. 2. "ATTESTED" (Head of the Office)
