Specimen for advertisement in newspaper

I, ____________________________________________ (old name) W/o, S/o,

D/o _________________________________ R/o _________________________ Chandigarh

have changed my/my minor son’s/my minor daughter’s name from _________________ (old

name) to __________________________________________ (new name).

 Application for Change of Name
To
The Controller,
Printing and Stationery Department,
U.T., Chandigarh.

Subject : Regarding Change of Name.

I want to change my name from _______________________________________

to _________________________________________. Necessary documents i.e. newspaper,

declaration and photocopy of residence proof are enclosed herewith. You are requested to kindly

publish the same in the Chandigarh e-Gazette notification.

Thanking you,

Yours faithfully,

Dated : Signature of applicant : ________________

Name : (Old Name) ___________________

Address : ____________________________

__________________________ Chandigarh.

Mobile : _____________________________

------------------------------------------------- For Office Use --------------------------------------------

Payment received vide FR No. _________________ dated __________________ for Rs. 50/- pl.
______________________________________________________________________________

Forwarded in original to the Deputy Controller (Ptg.) to publish the same in the

Chandigarh e-Gazette Notification please.

Supdt. (Pub.)
-----------------
D.C. (Ptg.)
 DECLARATION

I, _____________________________________________ (Old name)

W/o, S/o, D/o ___________________________________ R/o ___________________

________________________________________________Chandigarh have changed

my/my minor son’s/daughter’s name from ____________________________________

(Old name) to __________________________________________ (New name).

“I, _____________________________________________W/o, S/o, D/o

_________________________________________________________ aged ________

R/o ________________________________________________________________

Chandigarh verify that above contents are correct to the best of my knowledge and

belief and nothing has been concealed therein. I am aware that in case the information

furnished above is found to be incorrect, I shall be liable for prosecution Under Section

177 and 191 of the Indian Penal Code, which stipulates imprisonment and fine.”

Photograph

Signature of the applicant