Form No.G-625 Serial No. (to be left blank) HIMACHAL PRADESH BOARD OF SCHOOL EDUCATION DHARAMSALA-176213 FORM OF APPLICATION FOR CHANGE IN NAME Note-1 The applicant should carefully read the rules given on page 4 and comply with same before filling in the form.. Utmost care should be taken to write correct spelling of name according to the Board certificates. 2. The applicant should sign the application as also the affidavit with old name . DECLARATION TO BE SUBMITTED BY THE APPLICANT: I (old name) .........................................son/daughter of ................................................. Regd. No.(if any).................................... do hereby solemnly declare that subject to the sanction of the Board, I have changed my name from............................................To.........................and that I am a minor and an affidavit duly sworn before the Magistrate /Oath Commissioner by my parents/guardian. I am a major and an affidavit duly sworn before the Magistrate/Oath Commissioner by myself is enclosed herewith. The necessary fee of Rs................................................is being remitted as under: (a) By postal order(s)/Bank Draft which is/are also enclosed herewith No.(s)of Postal Order(s)/Bank Draft and its /their value. 1.................................................................2.............................................. 3.................................................................4............................................. (Postal orders/Bank Draft should be drawn in favour of the Secretary,Board of School Education,Himachal Pradesh,Dharamsala); (b) Board Receipt No...................Date..............................(if fee has been acknowledged by the office .The particulars of the examination taken and being taken by me are as under:- Name of Examination Month and Year of Exam Roll No. Result 1............................................ ............................................................. Pass/Failed 2............................................. ...................................... ........ Pass/Failed 3............................................ ...................................... .............. Pass/Failed 4............................................ ........................................ ............. Pass/Failed 5............................................... ..................................... ........... Pass/Failed 6................................................ ................................... ............ Pass/Failed The following certificates in original are sent herewith: 1.............................................2...................................3............................................. 4.............................................5....................................6............................................ . The cutting from the newspaper in which I have notified the change in my name is pasted below: SPACE FOR Name of the Newspaper................................................. PASTING THE &CUTTING FROM Place of Publication.......................................................... THE Date of Publication......................................................... NEWSPAPER (Spelling of the proposed ....................................................................... change in name should be (Signature of the applicant with the old name) according to advertisement). Complete Address........................................................... ......................................................................................... Date................................... (To be filled in by the Board office) The applicant has completed all the formalities regarding Final Order change in name under the rules .Particulars regarding exam Change in name as results of the applicant have been verified. The name of the recommended is allowed. applicant in the Board record will now be as................... alias/nee.............................................................................. Clerk, Supdt., Section Officer, Asstt. Secretary SECRETARY Sr.Asstt. Declaration in the case of those who did not join a school affiliated to this Board but studied Privately. Declaration No.1 1.........................................son/daughter of .............................................. do hereby solemnly declare that I did not join any school/educational institution affiliated to the Board of School Education, Himachal Pradesh, Dharamsala or to the University of the Himachal Pradesh ,Dharamsala but studied privately. Signature........................ ........................................... of attesting authority) (Signature of applicant) Designation................................ Dated:...................................... (Official stamp) Certificate by the Head of the Department Endst. No.................................... Dated:.............................. Certificate No.1. Forwarded to the Secretary, Board of School Education, Himachal Pradesh Dharamsala for necessary action with following remarks: (a) The office has no objection to this change. (b) The applicant is employed in this office since.................... (d) The entries made overleaf have been verified and found correct. Signature............................. Designation........................ (official stamp) Note: -The certificate is required from the candidates who are in service never remained on the rolls of any School/College affiliated to Himachal Pradesh University or to the Board of School Education, Himachal Pradesh, Dharamsala. Such candidates should submit their application through the Head of the Department where they are are employed. Certificate by the Head of the affiliated Institution, with Board of School Education, Himachal Pradesh, Dharamsala being attended or last attended. Endst.No..................... Dated......................... Certificate No.2 Forwarded to the Secretary, Board of School Education, Himachal Pradesh, Dharamsala for necessary action with the following remarks: (a)This office has no objection to this change. (b) The candidate is/was a student of ........................class of this school in the year............... (c) The entries made overleaf have been verified and found correct. Signature............................... Designation.......................... (official stamp) Attestation of the following persons will only be acceptable. (1) Gazztted Officer , (2) First Class Magistrate, (3)Headmaster/Principal of a affiliated school of this Board,(4) An officer of the Board not below the rank of Deputy Secretary. No.1 (SPECIMEN) FORM OF AFFIDAVIT IN THE CASE OF MINOR APPLICANTS (Applicant should write and sign his/her old name in the affidavit concerned) I.........................................................son/daughter......................................... do hereby solemnly declare that my son/daughter/ward is below eighteen years and has changed his/her name with my consent and that he/she is one and the same person. Signature............................ Deponent (Magistrate/Oath Commissioner) (Father/Guardian) Place................................... Address...................................... (official stamp) .................................................. ................................................ Dated:....................... No.2 (SPECIMEN) FORM OF AFFIDAVIT INTHE CASE OF MAJOR APPLICANTS I (old name..............................................................son/ daughter.of................................. do hereby solemnly declare that I am a major (over eighteen years) and have changed my name from .......................................................to................................................and that I am one and the same person. Signature................................ Deponent (Magistrate/Oath Commissioner) (Applicant) Place.................................... Address.............................................. (Official stamp) ........................................................... ............................................................ Dated:....................................... No.3 (SPECIMEN) FORM OF AFFIDAVIT IN THE CASE OF WOMEN APPLICANTS WHO ARE MARRIED I,(old name)........................................................daughter/son of Sh.................................. do hereby solemnly declare that I am a major (over eighteen years) and have changed my name from ............ To ............ due to marriage and that I am one and the same person. Signature............................... Deponent (Magistrate/Oath Commissioner) (Applicant) Address........................................... ...................................................... Place.............................. ..................................................... (official stamp) Dated..................................... RULES/INSTRUCTIONS REGARDING CHANGE IN NAME OF A CANDIDATE: 1. Any alteration in the name already recorded in the Board's office is considered as a change in name. 2. Middle/Matric/Senior Secondary (+1 & +2)Examination or any other examination passed or registered candidates of this Board are allowed to apply for change in their name. 3 To enable this office to expedite the matter, the applicant is advised in his own interest to remit the fee through IPO's/Bank Draft drawn in favour of the Secretary, H.P. Board of School Education, Dharamsala Disttt. Kangra(H.P.)Pin code No.176213 along with this application form or remit the fee in cash at the Board's counter Dharamsala. 4 The application should be forwarded to this office through the Head of Institution affiliated with this Board where the applicant is studying or last studied (Certificate No.2 at page 2 is meant for this purpose). 5. Women candidates change in whose name has been made due to marriage ,have to submit an affidavit on Rs.3/-Stamp Paper as per specimen as given in the Sr.No.3 at page 3 duly attested by a Magistrate /Oath Commissioner. 6. Affidavit on Rs.3/-Stamp Paper duly sworn before a Magistrate/Oath Commissioner by the parent or guardian of the applicant in case he is minor, or by himself in case he is a major is acceptable. The affidavit should be given as per specimen as given at Sr.,No.1 or 2 at page No.3 7. A cutting from the newspaper in which the applicant has advertised the change in his/her name be pasted in the space provided for it, and page of the newspaper be attached along with this form. Attested copy is not acceptable. 8. Duplicate certificates with changed name can be issued on payment of the prescribed fee and on return of the original certificates. This fee will be in addition to the fee paid for change in name. 9. Addition of Surname/Sub Caste is not permissible under the rules. 10. If the change in name is permitted, the name in the Board's record as well as in the duplicate copies of the certificates will be shown as "NEW NAME" alias "OLD NAME"as example, where change in name is allowed from "Megh Raj to Raj Kumar,"changed name in the Board's records as well as in the duplicate certificate will be shown as "Raj Kumar alias "Megh Raj",. 11. Incomplete case shall not be entertained for which the candidate shall be responsible himself.
