Proforma 1 Form – Fill Out and Use This PDF

For Change of Name

of Minor Only

In case of

Minor, a recent

Passport size photo of the Parent/ Guardian should be affixed with due self attestation

PROFORMA - I		S.No.
(This Proforma is intended for the Change of Name only)
Please read the instructions on the reverse	*Use on one box for one alphabet
side of this Proforma carefully and fill up	*Leave one box blank after each word
the particulars in the BOXES IN ENGLISH	*Do not split the word
(BLOCK LETTERS ONLY)	*Use next line

Affix a recent Passport Size Photo with due self attestation

From: Thiru / Selvi / Thirumathi

I , ( O l d N a m e ) [Proof of Old Name: Birth Certificate/School TC Must be

M y S o n / D a u g h t e r [ F o r M i n o r ] *

enclosed]

Initial

Son / Daughter / Wife of Thiru

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 :

PIN Code

Number

Shall henceforth be known as (NEW NAME IN BLOCK LETTERS)

[PIN Code must be Written, without Pin

code form will be returned]

Gazette to be got inperson

by post

(i) Signature

Station :

(As in the column of Old Name)

To be Published in the Tamil Nadu Government Gazette.

(iii)I hereby declare that I shall be held responsible for any (ii) misinformations funished by me.

*Signature of Parent or Guardian (if parents deceased) in the case of minors with relationship in BLOCK LETTERS.

1.M‡íŠðˆF™ M‡íŠðî£ó˜ ñ†´«ñ ¬èªò£Šð‹ Þì«õ‡´‹. M‡íŠðî£ó˜ 18 õò¶ ̘ˆF ܬìò£îõó£è (Minor) Þ¼‰î£™, î, î£ò£˜ Ü™ô¶

ð£¶è£Šð£÷˜ ñ†´«ñ ¬èªò£Šð‹ Þì«õ‡´‹.

ð£¶è£Šð£÷ó£è Þ¼ŠH¡ Üõ˜ ð£¶è£Šð£÷ó£è GòI‚èŠð†ìîŸè£ù ݬí ïè™ (Legal Guardianship Order) ꣡ªø£Šð‹ ªðøŠð†´ Þ¬í‚èŠðì «õ‡´‹. ¬èªò£ŠðˆF¡W› àøM¡ º¬ø¬ò (Capital Letter-™) î// ð£¶è£Šð£÷˜ ªðò¼ì¡ °PŠHì «õ‡´‹.

2.ñÂî£ó˜ ÝõíƒèO™ ²ò ꣡ªø£Šð‹ Þì«õ‡´‹.

3.ªðò˜ ñ£Ÿø ÜPM‚¬è îI›ï£†¬ì «ê˜‰îõ˜èÀ‚° ñ†´«ñ. ÜîŸè£ù àÁFªñ£NJ¬ù àKò ÞìˆF™ ÜO‚è «õ‡´‹.

4.ªðò˜ ñ£ŸøˆFŸè£ù è£óí‹ ªîKM‚è «õ‡´‹.

5.ªðò˜ ñ£Ÿø‚ è†ìí‹: 9-2-2004 ºî™ Ï. 415/- ñ†´‹.

6.ªê½ˆ¶‹ º¬ø:

«ïK™ : ðíñ£è

î𣙠Íô‹: àîM Þò‚°ï˜ (ªõOf´èœ) ⿶ªð£¼œ Ü„²ˆ ¶¬ø Þò‚°ïóè‹, ªê¡¬ù-600 002, â¡ø ªðòK™ «îYòñòñ£‚èŠð†ì õƒA õ¬ó«õ£¬ôò£è.

7.ðí‹ ªê½ˆ¶‹ «ïó‹:

ºŸðè™: 10.00 ñE ºî™ 1.00 ñE õ¬ó

HŸðè™: 2.00 ñE ºî™ 3.00 ñE õ¬ó (Üó² M´º¬ø Fùƒèœ cƒèô£è).

8.ðí M¬ìˆî£œ (ñ) Ü…ê™ Ý¬íèœ ãŸèŠðìñ£†ì£¶.

9.ðí‹ ªê½ˆ¶õ¶ ªî£ì˜ð£è M‡íŠðî£ó¼‚° G¬ù׆´ 㶋 ÜŠðŠðìñ£†ì£¶.

10.Þˆ¶¬øò£™ õöƒèŠð´‹ M‡íŠðŠ ð®õ‹ (ñ) ðFMø‚è‹ ªêŒòŠð´‹ ð®õƒèœ ãŸÁ‚ªè£œ÷Šð´‹. ¹¬èŠðì ïè™ ð®õ‹ ãŸèŠðìñ£†ì£¶.

11.M‡íŠðî£ó˜ îMó «õÁ ò£¼ì‹ â‰îMî ªî£ì˜¹‹ ªè£œ÷Šðì ñ£†ì£¶.

12.M‡íŠðî£ó˜ ºèõKJ™ êKò£ù èî¾ Þô‚è‹ ñŸÁ‹ H¡«è£´ ⇠îõø£ñ™ °P‚è «õ‡´‹.

13.Hø‰î ñ£õ†ìˆF¡ ªðò˜ ñ†´«ñ °PŠHì «õ‡´‹.

14.ºîªô¿ˆ¶‚°‹ ªðò¼‚°‹ Þ¬ì«ò ܬñò «õ‡®ò ¹œOèœ êKò£è °PŠHì «õ‡´‹.

15.M ‡ í Š ð î £ ó ˜ ð¬öò ªðòK™ ¬ è ª ò £ Š ð I ì «õ‡´‹.

16.M‡íŠðî£ó˜ 60 õò¶‚° «ñ™ àœ÷õó£ù£™ ðF¾ ªðŸø ñ¼ˆ¶õKìI¼‰¶ Life Certificate Üêô£èŠ ªðŸÁ Þ¬í‚è «õ‡´‹.

17.«ñ½‹ Mõó ƒ èÀ‚° àîM Þò‚°ï˜ (ªõ), ªê¡¬ù-2 Þ™ 2852 0038, 2854 4412 ñŸÁ‹ 2854 4413, 28544414 â¡ø ªî£¬ô«ðC â‡E™ ªî£ì˜¹ ªè£œ÷ô£‹.

18 . ð¬öò ªðò˜ ( ñ ) ¹Fò ªðòK™, “â¡Aø” (Alias) â¡Á

Hó²K‚è Þòô£¶.

19.Hó²ó‹ ªêŒòŠð†ì ÜóCîN™ Ü„²ŠH¬öèœ ã¶I¼ŠH¡ ÜõŸ¬ø ÝÁ ñ£îˆFŸ°œ êKªêŒ¶ ªè£œ÷ «õ‡´‹. ÜŠH¡ H¬öè¬÷ F¼ˆî‹ ªêŒò‚«è£¼‹ âšMî «è£K‚¬è»‹ 臮Šð£è ãŸèŠðìñ£†ì£¶.

20.HøŠ¹ / è™M„ ꣡Pî› Þ™ô£îõ˜èœ õòF¬ù GÏH‚è Üó² ñ¼ˆ¶õKì‹ àKò ꣡Pî› ªðŸÁ êñ˜ŠH‚è «õ‡´‹.

21.êeðˆF™ â´‚èŠð†ì M‡íŠðî£óK¡ ¹¬èŠð숬î, Üèù ÜO‚èŠð†´œ÷ ÞìˆF™ 冮, ñÂî£ó˜ ²ò ꣡ªø£Šð‹ Þì«õ‡´‹.

22.ÜóCî¬ö «ïK™ªðø M¼Šð‹ ªîKMŠðõ˜èœ, ÜóCî› Hó²K‚èŠð†ì 5 èÀ‚°œ «ïK™ õ‰¶ ÜóCî¬ö ªðŸÁ‚ ªè£œ÷ «õ‡´‹. îõPù£™ ÜóCî› î𣙠Íô‹ àKò ï𼂰 ÜŠðŠð´‹.

23.î𣙠Íô‹ ÜŠðŠð´‹ ÜóCî›èœ, î𣙶¬ø Íô‹ F¼ŠðŠð´‹ ð†êˆF™, ÜóCî›èœ, àKò ïð˜èÀ‚° e‡´‹ î𣙠Íô‹ ÜŠðŠðìñ£†ì£¶. Þ¶ «ð£¡ø G蛾èO™, àKò ïð˜èœ 6 ñ£îƒèÀ‚°œ «ïK™ õ‰¶, î𣙶¬ø Íô‹ F¼ŠðŠð†ì, Üõ˜èÀ‚è£ù ÜóCî›è¬÷Š ªðŸÁ„ ªê™ôô£‹.

24.²iè£ó‹ ªî£ì˜ð£è ªðò˜ ñ£Ÿø‹ ªêŒ»‹ ð†êˆF™, ²iè£ó‹ â´ˆ¶œ÷ î (ñ) î£ò£˜ ñ†´«ñ, ªðò˜ ñ£Ÿø‹ ªêŒò M‡íŠHˆ¶, ð®õˆF™ àKò ÞìˆF™ ¬èªò£Šð‹ Þì «õ‡´‹.

ެ특:

I.îI›ï£†®™ Hø‰¶ îI›ï£†®«ô«ò õCŠðõ˜èœ ªðò˜ ñ£Ÿø‹ ªêŒò Ýî£óñ£è ð¬öò ªðò¼‚° à‡ì£ù HøŠ¹ ꣡Pî› ïè™/è™M ꣡Pî› ïè™/ê£F ꣡Pî› ïè™ Þ¬í‚è «õ‡´‹. i†´ Mô£êˆFŸ° Ýî£óñ£è àí¾ ðƒW†´ ܆¬ì/õ£‚è£÷˜ ܬìò£÷ ܆¬ì/ èì¾ Y†´ ïè™ ÞõŸP™ ã«î‹ å¡P¡ ²ò ꣡P†ì ïè™ Þ¬í‚è «õ‡´‹.

II. Hø ñ£GôˆF™ Hø‰¶, îI›ï£†®™ õCŠðõ˜èœ îI›ï£†®™ õCŠð Ýî£óñ£è HøŠ¹ ꣡Pî› ïè™/ àí¾Š ðƒW†´ ܆¬ì/õ£‚è£÷˜ ܬìò£÷ ܆¬ì/ õ†ì£†CòKì‹ Þ¼‰¶ ªðøŠð†ì Þ¼ŠHì„ ê£¡Á, ÞõŸP™ ã«î‹ å¡P¡ ꣡P†ì ïè™ Þ¬í‚è «õ‡´‹.

III. ²iè£ó‹ â´ˆ¶‚ ªè£‡´, Üîù£™ ªðò˜ ñ£Ÿø‹ ªêŒ«õ£˜

W›‚è‡ì Ýõíƒè¬÷ êñ˜ŠH‚è «õ‡´‹.

1.²iè£ó î/ Þ¼ŠH¡ Üõ˜èœ ²iè£ó‹ ðF¾ªêŒòŠð†ì ²iè£ó ðˆFó ïèL™ ñÂî£ó˜ ²ò ꣡ªø£Šð‹ Þì «õ‡´‹, HøŠ¹ ꣡Pî› ñŸÁ‹ °´‹ð ܆¬ì ïè™ Þ¬í‚èŠðì«õ‡´‹.

2.²iè£ó‹ ªè£´‚èŠð†ì ñè¡/ñèO¡ ²iè£ó î/  Þ¼õ¼‹ è£ô‹ îõP Þ¼ŠH¡ Þî¬ù Üó² ªõOf†®™ “ªð£¶ ÜPM‚¬èò£è” ñ†´«ñ ªõOJì Þò½‹. ÞîŸè£ù Ýõíƒèœ (ñ) ðF¾ ªêŒòŠð†ì ²iè£ó ðˆFó ïèL™ ñÂî£ó˜ ²ò ꣡ªø£Šð‹ Þì «õ‡´‹, HøŠ¹ ꣡Pî› ïè™, °´‹ð ܆¬ì ïè™ Þ¬í‚èŠðì «õ‡´‹.

IV. Mõ£èóˆ¶ ªêŒ¶ Üîù£™ ªðò˜ ñ£Ÿø‹ ªêŒ«õ£˜ cFñ¡ø b˜ŠH¡ ïèL™ ñÂî£ó˜ ²ò ꣡ªø£ŠðI†´ Þ¬í‚è «õ‡´‹.

ªðò˜ / ñîñ£Ÿø‹ Hó²óñ£ù ÜóCî› ªðÁ‹ º¬ø:

M‡íŠðî£ó¼‚° Üõó¶ ªðò˜ / ñîñ£Ÿø‹ Hó²óñ£ù ÜóCîN¡ 5 ïè™èœ ðF¾ˆ îð£™Íô‹ ÜŠH ¬õ‚èŠð´‹. Ã´î™ HóFèœ «î¬õŠð®¡ îQ«ò ðíñ£è«õ£/«è†¹ õ¬ó«õ£¬ôò£è«õ£ ªê½ˆFŠ ªðøô£‹.

ªðò˜ / ñîñ£ŸøŠ ð®õˆ¬î Þˆ¶¬ø Þ¬íòî÷ˆF™ ðFMø‚è‹ ªêŒ¶ ªè£œ÷ô£‹. Þ¬íòî÷ ºèõK :

http:/ www.stationeryprinting.tn.gov.in

1.Applicant alone should sign in the application (OLD NAME).

In case of minor (18 years below) the parents / guardian should sign in the column provided. Incase of guardian an attested copy of the Legal Guardianship order must be enclosed. The relationship of the person signing the form must be mentioned in Capital Letters.

2.Documents shall be self attested.

3.Notice for change of name will be entertained only in respect of persons who are native of this State for which they should give declaration in the column provided.

4.The reason for change of name shall be furnished.

5.Fees: Rs. 415/- from 9-2-2004.

6.Method of Payment :

In person : Cash

By Post : Demand Draft in favour of Assistant Director (P), Directorate of Stationery and Printing, 110, Anna Salai, Chennai-600 002,

drawn from a Nationalised Bank. Payable at Chennai Lapsed Demand Draft should be got revalidated by the individual through the respective banks.

7.Working Hours: For Payment Forenoon : 10.00 a.m. to 1.00 p.m. Afternoon : 2.00 p.m. to 3.00 p.m. (Except Government Holidays)

8.Money Order/Indian Postal Orders are not accepted.

9.No reminder to the party either for remittance or for any other particulars will be sent.

10.The application issued by this Department Alone will be accepted. Xerox copy will not be accepted. But forms can be downloaded from the website given below.

11.No correspondence will be entertained with any persons other than the applicant.

12.Correct Door No. & PIN Code Number should be written in the address without fail.

13.Specify the Native District only. (District of Birth)

14.Specify the punctuations in between Initials and Name accurately.

15.Applicant should sign in old name only.

16.Life Certificate may be obtained from the Government Medical Practioner and to be enclosed, in original if the applicants age is 60 and above.

17.For further details contact Assistant Director (P), Chennai-2, Phone No. 2852 0038, Store Section No. 2854 4412, Despatch Section No. 2854 4413, 28544414.

18.“Alias” name cannot be published in Old Name & New Name.

19.Any discrepancies found in the Gazette in the printed matter could be rectified within a period of six months, after which, any request for correction of mistakes in the Gazette, will not be entertained.

20.Those who do not have birth / educational certificate, should enclose a copy of the certificate issued by a Doctor Working in any of the Govt. Hospitals, as a proof of age.

21.A recent passport size photograph of the applicant must be affixed in the space provided for it, and should be self attested.

22.Those who opt to get the Gazettes in person, must get them within 5 days from the date of publication of the Gazette. Otherwise it will be sent by post.

23.Gazettes sent by post to the applicants residential address if returned by the Postal Department, will not be sent to the applicant again by Post. In such instances, the concerned person can collect his / her ‘Returned Gazette’ in person from this office, within a period of 6 months from the date of publication of the Gazette.

24.In case of “Adoption”, only the father who adopts the child should apply for change of name, and he has to sign in the space provided for signature of the applicant.

Enclosure:

I.Those who are born and reside in Tamil Nadu should produce the Old Name Proof Copy of Birth Certificate or School Certificate or Community Certificate and Residential Proof Copy of Ration Card/Voter Identity/Pass Port should be enclosed.

II.Those who are born outside the State of Tamil Nadu and residing in Tamil Nadu duly certified copy of the Birth Certificate or Ration Card/Voter Identity/Residential Certificate issued by Tahsildar should be enclosed.

III.Change of Initial, name due to adoption:

1.The Adopted Father/Mother should sign in the applica- tion. The following documents should be enclosed with the form. Copy of the registered Adoption Deed with Attestation, Birth Certificate and Ration Card Xerox.

2.In case both the Adopted Father/Mother are expired the Adopted Son/Daughter can publish in the Government. Gazette as a “Public Notice”. The following Documents are to be attached with the Notification, copy of the registered Adoption Deed with Attestation, Birth Certificate and Ration Card Xerox.

IV. Change of name due to divorce:

Duly Certified Copy of Judgement to be enclosed. In case of of Re-Marriage, Marriage Certificate should also be enclosed.

Five copies of Tamil Nadu Government Gazette will be sent to the Applicant in which his name change has been published by Registered Post. Additional Copies will have to be purchased from the Assistant Director (P), Directorate of Stationery and Printing, 110, Anna Salai, Chennai-600 002 on payment of cost by means of D.D. or cash.

Change	of Name	form down	Load can be done
f r o m	o u r	D e p a r t m e n t	W E B S I T E : h t t p : / /

www.stationeryprinting.tn.gov.in