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AFFIDAVIT FOR CHANGE OF NAME

By this deed I, the undersigned MR. PAUL PATRICK D’COSTA,

previously called MR. PAUL INACINHO D’COSTA, occupation: ____,
resident of 106, Riddhi-Siddhi Complex, Manickpur Talav, Near Nirmala
school, Manickpur, Vasai (West), Dist., Palghar, Maharashtra-401202, do
hereby solemnly declare, affirm and state as under:
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1. That in the Passport bearing no. F7145668 my name is wrongly

mentioned as MR. PAUL INACINHO D’COSTA and the same
needs to be rectified and corrected as MR. PAUL PATRICK
D’COSTA as mentioned in my Aadhar Card bearing no.
744855159201 and PAN card bearing No. AKKPD8514C

2. That, I am making this Affidavit, to be submitted to the Passport

Authority to correct my wrongly mentioned name from MR. PAUL
INACINHO D’COSTA to be corrected and read as MR. PAUL
PATRICK D’COSTA.

3. That for and on behalf of myself, I wholly renounce, relinquish and

abandon the use of my former name MR. PAUL INACINHO
D’COSTA and in place thereof I do hereby assume from this date
the name MR. PAUL PATRICK D’COSTA so that I may hereafter
be called, known and distinguished not by my former name, but
assumed name MR. PAUL PATRICK D’COSTA.

4. That for the purpose of evidencing such, my determination declare

that I shall at all times hereafter in all records, deeds and writings
and in all proceedings, dealings and transactions, private as well as
upon all occasions whatever use and sign the name of MR. PAUL
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PATRICK D’COSTA as my name in place and in substitution of

my former name MR. PAUL INACINHO D’COSTA.

5. That I expressly authorize and request all persons in general and

relatives and friends in particular, at all times hereafter to designate
and address me by such assumed name of MR. PAUL PATRICK
D’COSTA accordingly and all the records where it is wrongly
mentioned be corrected as MR. PAUL PATRICK D’COSTA.

6. I state that “MR. PAUL INACINHO D’COSTA” (earlier name)

and “MR. PAUL PATRICK D’COSTA” (present name) is the
name of one and the same person and that is myself.

7. I say and submit that I have also given Public Notice on ________ in
_________ Newspaper, to notify the public at large for correction of
my Name as MR. PAUL PATRICK D’COSTA instead of MR.
PAUL INACINHO D’COSTA.

8. In witness whereof I adopt my name as MR. PAUL PATRICK

D’COSTA and affix my signature here.

Place: Mumbai

Dated this ___ day of August, 2021

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Signed, sealed and delivered by the above named

Former Name: MR. PAUL INACINHO D’COSTA

New Name: MR. PAUL PATRICK D’COSTA

Witness: -

Name: _________________________ Signature __________

Add: _____________________________

_________________________________

_________________________________

Name: __________________________ Signature____________

Add: _____________________________

_________________________________

_________________________________
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VERIFICATION

I, MR. PAUL PATRICK D’COSTA, resident of 106, Riddhi-Siddhi

Complex, Manickpur Talav, Near Nirmala school, Manickpur, Vasai
(West), Dist., Palghar, Maharashtra-401202, do hereby state and verify that
whatever is stated herein above is true, correct and to the best of my
knowledge and belief.

Solemnly affirmed at Mumbai )

On this ____ day of August 2021)

(Signature of the Applicant)

Mr. Paul Patrick D’Costa

Identified by me, Before Me,

Ms. Shruti Lakhani

Advocate