AFFIDAVIT

I, Champa Pandharinath Bhoir W/o Late Shri PAndharinath

Shriram Bhoir, ADHAR UID no 959068522552 PAN NO
APSPB0437K aged around 56 years, resident of A/104, HIRA
HARISHCHANDR APT. KALYAN TISGAON ROAD,
KOLSHEWADI, SIDDHARTH NAGAR, KALYAN EAST,
THANE, 421306 mobile no 9224463560 do hereby solemnly affirm
and declare as under:
 1. That I am wife of Late Shri Pandharinath Shriram Bhoir, who was a
pensioner as per the PPO order my name as per the record is wrongly
mentioned as CHANDABAI PANDHARINATH BHOIR as it should be as
CHAMPA PANDHARINATH BHOIR.
2. My Adhar Card Name is correct Champa Pandharinath Bhoir.
3. I state that in some records as my name mentioned as Champavati Valku
Mhase alias Champabai Pandharinath Bhoir alias Chandabai Pandharinath
Bhoir alias Champa Pandharinath Bhoir is the name of one and the same
person and that is myself.
4. That I have changed my name as CHAMPA PANDHARINATH BHOIR
___-___ __________ 2022 through the gazettee notification registration no
M-____________
5. At present all the records have my new name CHAMPA PANDHARINATH
BHOIR.
6. We hereby state that, I am executing this declaration to be submitted to the
concerned authorities for the change of name.

I hereby state that whatever is stated herein above are true to the best of my
knowledge.

Solemnly affirmed at Thane On this ___ ________, 2022

(Signature of the Applicant).

Deponent

VERIFICATION

Verified on this day this ______________ at Thane that the contents of the
affidavit are true and correct, nothing material has been concealed and no part of it
is false.

Deponent.

I know and identify the applicants personally since 34 years

ADV. ASHWINI AVINASH KOR

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eks- 8454041848 adv.aakor@gmail.com / korashwini20@gmail.com