To,

THE CHAIRPERSON, Date:

Karnataka School Examination
and Assessment Board,
6th Cross Rd, Malleshwara,
Bengaluru, Karnataka 560003

Subject: Change of Name and Gender.

I, Mr. Ayush Singh.G (previously Ms.Shruthi.G) would like to bring it to your

attention that I recently underwent “Gender reassignment surgery”. In essence, I was
born as a female but since I did not feel comfortable being in the body that I was
assigned during my birth, I decided to undergo a surgery changing my gender from
female to male.

To give a brief about myself, I would like to state that I was born on 01/06/1991 at
Kukanoor, Koppal district and I’m the last child of the four children that was born to
my parents. I state that I have completed my 1st standard to 7th standard at Sri.
Buvaneshwari aided higher primary school and 8th to 10th studied in Sharada Nikethan
English Medium high school and both are situated at S.N.Pete, Kampli, Bellary
district. Furthermore, I completed my I & II PUC from Vijayanagara College, Hospet
and completed Bachelor of Computer Application from Gulbarga university and
M.Sc in computer science from Vijayanagara Sri Krishnadevarya university in
Bellary.

I state that, for most part of my life I was raised in the Hyderabad-Karnataka region
and as such the Assistant Commissioner, Hospet sub division had issued a regional
certificate in my favour as envisaged under Article 371-J. In addition, the Tahsildar
Kampli Taluk had also issued a caste cum income certificate along with domicile/
residence certificate in my favour.

It is pertinent to state that, I underwent surgery for removal of breasts at Designer

body, Mumbai on 31/08/2021 and subsequently, I underwent “Total Laproscopic
Hysterectomy with Bilateral Salphin Goophorectomy” at Kokilaben Ambani
Hospital, Mumbai. Finally, I underwent Phalloplasty in order to replace my genitals.

It is trite to state, ever since I underwent the aforementioned surgeries I have been
living as a man and I also identify as a man. Nonetheless, all my documents vis-à-vis
school and college marks card, AADHAR, PAN card, etc., reflect my name as Ms.
Shruthi.G as I was a woman before. Now that my gender has been
reassigned/changed, it is necessary that the gender and the name in my SSLC marks
Card is also changed to Male and Mr. Ayush Singh.G.

I state that I’m currently unemployed though I’m well qualified to get an employment.
It is pertinent to mention that, most work places ask for personal details such
AADHAR card and marks card to get an employment but given my story, nobody
believes that I have undergone gender reassignment surgery. I’m even deprived of the
basic necessities as I’m unable to get a job. That apart, I’m finding it difficult to travel
and stay in places as most places in Bangalore ask for some kind of Identity card and
I’m unable to provide the same as all the documents that are in my possession are in
respect of Ms.Shruthi.G. In light of the above, I humbly request your goodself to
consider my representation and effect change in my gender and name in SSLC marks
Card .

I’m herewith enclosing the SSLC marks Card and AADHAR Card for your perusal.

Yours Sincerely,

(Mr.Ayush Singh.G)

From:
No.4, 3rd Floor, 4th Cross,
5th Main, Sampangiramanagara, Bengaluru South,
Bengaluru-560027