Adapt the format to the facts and to the specific requirements of the board, university, notary or other competent authority. Delete clauses that do not apply.
AFFIDAVIT FOR CHANGE / CORRECTION OF NAME IN EDUCATIONAL CERTIFICATE
I, [FULL NAME OF DEPONENT], son/daughter/spouse of [NAME], aged about [__] years, residing at [FULL ADDRESS], do hereby solemnly affirm and state as follows:
1. That I am the applicant seeking correction/change of my name in the educational record/certificate issued by [NAME OF BOARD / UNIVERSITY / INSTITUTION].
2. That I passed/completed [EXAMINATION / COURSE] in the year [YEAR] under Roll No./Registration No. [NUMBER].
3. That my name is presently recorded in the said certificate/record as
"[OLD / INCORRECT NAME]".
4. That my correct/changed name is "[NEW / CORRECT NAME]".
5. That the correction/change is sought because [STATE THE REASON BRIEFLY
- e.g. spelling error, alignment with birth/public records, marriage, adoption of surname, or lawful change of name].
6. That "[OLD / INCORRECT NAME]" and "[NEW
/ CORRECT NAME]" refer to one and the same person, namely myself.
7. That I am submitting the documents required by the concerned authority in support of this request, including [LIST RELEVANT DOCUMENTS].
8. That this affidavit is made for submission before [BOARD / UNIVERSITY / INSTITUTION / OTHER AUTHORITY] for correction/change of my name in its records and for issuance of the corrected/revised certificate, if permitted under the applicable rules.
DEPONENT
VERIFICATION
I, the above-named deponent, verify that the contents of paragraphs 1 to 8 are true and correct to my knowledge and belief and that nothing material has been concealed therefrom.
Verified at [PLACE] on this [DAY] day of [MONTH, YEAR].
DEPONENT