APPLICATION FOR INCLUSION OF NAME-FORM

APPLICATION FOR NAME INCLUSION
...............MUNICIPALITY/CORPORATION/GRAMAPANCHAYAT
1.Date of Birth :
2.Place of Birth :
3.(1) Father's Name :
(2) Mother's Name :
4. Address :
5. Registration Number(If known) :
6.Name to be included
In Malayalam :
In English (In Capitals) :



DECLARATION
We hereby declare and agree that that we are fully aware of the fact that the name once included cannot be changed later and that we would not demand for a name change later.


Signature of Father.......................... Signature of Mother...............
Place.........................
Date..........................
..........................................................................................................................................................................
Acknowledgement
File Number.........................
Name and Address of Applicnt:
Date of receipt of Application:
Details of remittance of fees:
(No. & Date of Receipt Issued) Registrar