Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
of Minor Only
PROFORMA - I
In case of
Minor, a recent
Passport size
photo of the
Parent/
Guardian
should be
affixed with
due self
attestation
S.No.
I, (Old Name)
Affix a
recent
Passport
Size Photo
with due
self
attestation
Initial
Born on
Date
Month
Year
Sex
Age
Male / Female
District of Birth :
Residing at : [Xerox copy of Ration Card / Voter ID / Passport /Driving Licence should be enclosed]
Door No. Old :
New :
by post
(i) Signature.............................................................
(As in the column of Old Name)
Station :
Date
PIN Code
Number
[PIN Code must be Written, without Pin
LETTERS) code form will be returned]
(iii)
SELF ATTESTATION
The information furnished above are correct and true to the best of my knowledge and belief.
......................................................................
Signature of the Applicant with name in BLOCK LETTERS
FOR OFFICE USE ONLY
Mode of Payment Cash / DD For Rs.
R.V. No. :
Date :
Receipt No. :
R.V. Clerk.
Superintendent.
[P.T.O.
F
2- MH .
-2
G:
1. MF M
. M 18 F
(Minor) , ,
.
H
GI (Legal Guardianship
Order) .
FW M (Capital Letter-)
// PH .
2. O .
3. PM I
.. FNJ K F O
.
4. F KM .
5. : 9-2-2004 . 415/- .
6. :
K :
: M (Of)
, -600 002, K
Y A .
7. :
: 10.00 E 1.00 E
H: 2.00 E 3.00 E
( M F c).
8. M () .
9. M
G .
10. M ()
FM .
.
11. M M M
.
12. M KJ K
H P .
13. H F PH .
14.
O K PH .
15. M
.
16. M 60 F
KI Life Certificate
.
17. M M ( ) ,
-2 2852 0038, 2854 4412 2854
4413, 28544414 C E
.
18. ( ) F K, A (Alias)
HK .
19. H C N H
IH F K
. H H F
M K
.
20. H / M P F GH
K K P H
.
21. eF MK ,
O F ,
.
22. C K M KM, C
HK 5 K C
. P C
K .
23. C,
F F, C, K e
. GO,
K 6 K ,
F, C
.
24. i F,
i () ,
MH, F K F
.
:
I. I H I C
H P /M P /F P
. i MF
W / /
Y P P P
.
II. H GF H, I C
I C H P /
W / /
CK H ,
P P P
.
III. i ,
W H .
1. i / H i
F i F L
, H P
.
2. i /O i /
P H
Of PM
OJ . () F
i F L
, H P ,
.
IV. M
cF bH L I
.
/ H C :
M /
H CN 5 F
H . HF
Q /
F .
/ F
. K :
FM
http:/ www.stationeryprinting.tn.gov.in
3
THIS PROFORMA IS INTENDED FOR THE CHANGE OF NAME ONLY
If the change of name is due to the change of religion a separate form
(PROFORMA-II) is available and will be sent on application.
Instructions for Filling the Application
CONDITIONS:
1. Applicant alone should sign in the application (OLD NAME).
www.stationeryprinting.tn.gov.in