IN THE COURT OF EXECUTIVE MAGISTRATE:

EAST SIANG:DISTRICT:PASIGHAT:ARUNACHAL PRADESH:

AFFIDAVIT

I Sharma Nishad, S/O Late Bhoj Bin, age about 43 years,Resident of Village-
Gauri, Jagdish-Bintoli,P/O Gauri-Jagdish, P/S-Sewarahi, District-Kushinagar , State-
Uttar Pradesh ,do hereby solemnly affirm and declare as follows:-

1. That I am a bonafied citizen of India and a resident of the aforementioned

address.
2. That from now onwards my name to be knowns as Sharma Nishad which is
being used in all my officials documents records and other correspondences.
3. That, I have mistakenly written my name in Lfe Insurance Corporation
(LIC), Policy no.441805423 as Sharma Nisad which is wrong.
4. That this affidavit is being sworn and signed before the Court of Law to declared
that Sharma Nisad and Sharma Nishad are treated as the same and one
person and which shall used as piece of evidence in all respect.
5. That the statements made above are true and correct to the best of my personal
knowledge and belief and hence,I Swear and Sign this affidavit before the Court
of Executive Magistrate First Class, Pasighat ,East Siang District, Arunachal
Pradesh, on the day of ………………………………….

DEPONENT

Sworm and signed by the Deponent, before me on this ……… day of ………… 2021 and
hence,this Affidavit in duly sworm and affirmed in my court.

Executive Magistrate
East Siang:District,Pasighat:
Arunachal Pradesh