Proforma 2

PROFORMA II Please read the instructions on the reverse side of this Proforma carefully and fill in all particulars in the BOXES IN ENGLISH (BLOCK LETTERS ONLY)

* Use one box for one alphabet only * Leave one box blank after each word * Do not split the word * Use next line

From: Thiru / Selvi / Thirumathi

Residential Address :

District :

Pin :

Thiru / Selvi / Thirumathi

(Hindu / Christian / Islam)

Born on

Date

Month

To be published in the Tamil Nadu Government Gazette.

Son / Daughter / Wife of Thiru : Year

Native District :

Residing at :

has converted / reconverted to Hinduism / Christianity / Islam with the name of on

(i)

Station : Date

:

Signature............................................................. (As in the column of Old Name)

(ii) Signature of parent or guardian (if parents deceased) in the case of minors with relationship in BLOCK LETTERS.

Declaration (i) I hereby declare that I belongs to Scheduled Caste or Backward or Most Backward Class reconverted from Christianity to Hinduism. (ii) I hereby declare that I am a native of Tamil Nadu and residing permanently in Tamil Nadu. (iii) To prove the nativity, a certificate issued by the Tahsildar (or) Xerox copy of Ration Card should be enclosed.

(i) Signature................................................................... (As in the column of Old Name) (ii) Signature of parent or guardian (if parents deceased) in the case of minors with relationship in BLOCK LETTERS.

WITNESS The information furnished above are correct and true to the best of my knowledge and belief. ...................................................................... Name of the Witness in BLOCK LETTERS Status / Occupation and Address........................................... ................................................................................................ ................................................................................................

...................................................................... Signature of the witness (The witness should be in Gazetted of Tamil Nadu Government / Central Government Officers with seal.) [P.T.O.

DTP—373-63—10,000—10-2-06—[P4-17-E]

2

Þ‰îŠ ð®õ‹ ªðò˜ ñŸÁ‹ ñîñ£ŸøˆFŸ° àKˆî£ù¶ MFº¬øèœ 1. M‡íŠðº‹ ªðò˜ ñ£Ÿø ÜPM‚¬è ºîô£ù¬õèÀ‹ ªðò˜ ñ£Ÿø‹ ªêŒò M¼‹¹«õ£ó£™ ñ†´‹ ¬èªò£ŠðIìŠðì «õ‡´‹. ªê£‰îI™ô£î “Ü” ñŸÁ‹ “H” HK¾ îI›ï£´/ñˆFò Üó² ܽõô˜ å¼õó£™ ê£†Cò‹ ªðøŠð†´ ÜõK¡ Mô£êº‹ ªðøŠðì «õ‡´‹. ªðò˜ ñ£Ÿø‹ ªêŒò M¼‹¹«õ£˜ îMó «õÁ ò£¼ì‹ â‰îMî ªî£ì˜¹‹ ªè£œ÷Šðìñ£†ì£¶. ÞŠ«ð£¬îò ªðò¼‹ (ð¬öò ªðò˜) ¬èªò£Šðº‹ å¡ø£è Þ¼‚è «õ‡´‹. 2. ªðò˜ ñ£ŸøˆFŸ°Kòõ˜ àKò õòî¬ìò£îõó£è (Minor) Þ¼‚°‹ G¬ôJ™ Üõ¼¬ìò ªðŸ«ø£«ó£ Ü™ô¶ ð£¶è£õô«ó£ ªðò˜ ñ£Ÿø ÜPM‚¬èJ™ 嶂èŠð†´œ÷ ÞìˆF™ ¬èªò£ŠðI†´ ÜîŸè®J™ Üõ¼¬ìò ªðò¬ó»‹ ñŸÁ‹ ªðò˜ Ü™ô¶ ñî‹ ñ£ŸÁ‹ ï𼂰‹ Üõ¼‚°‹ àœ÷ àøM¡ º¬ø¬ò»‹ ÜPMˆî™ «õ‡´‹. 3. ªðò˜ ñŸÁ‹ ñî‹ ñ£Ÿø ÜPM‚¬è Þ‹ñ£Gôˆ¬î„ «ê˜‰îõ˜èÀ‚° ñ†´«ñ àKò‹. ÞŠð®õˆF™ àœ÷ àÁFªñ£N èôˆF™ Ü‡ì£ù àÁFªñ£N¬ò Üõ˜èœ ÜO‚è «õ‡´‹. «ñ½‹ Ü‡ì£ù ꣡P¬ù»‹ M‡íŠðˆ¶ì¡ Þ¬í‚è «õ‡´‹. ÞšõP‚¬èJ™ â‰îMî Ü®ˆî™ F¼ˆî½‹ Þ¼‚è‚Ã죶. 4. 䉶 ÜóCî› ð®èœ ñŸÁ‹ Ü…ê™ è†ìí‹ à†ðì ªðò˜ ñŸÁ‹ ñîñ£ŸøˆFŸ°Kò ðFŠd†´‚ è†ìí‹ ÝAò Ï. 415/- Þšõ½õôèˆF¡ ðí‹ ªðÁ‹ ÞìˆF™ (Cash Counter) 裬ô 10 ñE ºî™ HŸðè™ 1 ñE õ¬óJ½‹ ñŸÁ‹ HŸðè™ 2 ñE ºî™ 3 ñE õ¬óJ½‹ ªê½ˆîô£‹ Ü™ô¶ àîM Þò‚°ï˜ (ªõOf´èœ). Üó² ⿶ªð£¼œ ñŸÁ‹ Ü„²ˆ ¶¬ø ݬíòóè‹, 110, Ü‡í£ ê£¬ô, ªê¡¬ù-600 002 Üõ˜èœ ªðÁ‹ õ¬èJ™ «îCòñòñ£‚èŠð†ì õƒA å¡P™ ªðøŠð†ì «è£®†ì «è†¹ õ¬ó«õ£¬ô (Demand Draft) Íô‹

àîM Þò‚°ï˜ (ªõOf´èœ), Üó² ⿶ªð£¼œ ñŸÁ‹ Ü„²ˆ ¶¬ø ݬíòóè‹, 110, Ü‡í£ ê£¬ô, ªê¡¬ù600 002 Üõ˜èÀ‚° ÜŠðô£‹. ðíM¬ìˆî£œ (Money Order) ñŸÁ‹ Ü…ê™ Ý¬í (Postal Order) Íô‹ ÜŠðŠð´‹ ðFŠd†´ˆªî£¬è ãŸÁ‚ ªè£œ÷Šðìñ£†ì£¶. 5. ªðò˜ ñŸÁ‹ ñî‹ ñ£Ÿø‹ ªêŒ¶‚ ªè£‡ìõ¼‚«è£ Ü™ô¶ ò£¼¬ìò ªðò˜ ñŸÁ‹ ñîñ£Ÿø ÜPM‚¬è ªõOJìŠð†ì«î£ Üõ¼‚° ÜPMŠ¹ ªõOò£ù 䉶 ÜóCî› ð®èœ ðF¾ Ü…êL™ ÜŠH ¬õ‚èŠð´‹. «ñ½‹ ð®èœ «î¬õŠð®¡ Üõ˜èœ àîM Þò‚°ï˜ (ªõOf´èœ), ⿶ªð£¼œ ñŸÁ‹ Ü„²ˆ ¶¬ø ݬíòóè‹, 110, Ü‡í£ ê£¬ô, ªê¡¬ù-600 002 â¡ø Mô£êˆF™ îQò£è ðí‹ ªê½ˆFŠ ªðøô£‹. 6. ðí‹ ªê½ˆ¶î™ ªî£ì˜ð£è«õ£ Ü™ô¶ ñŸø MõóƒèÀ‚è£è«õ£ M‡íŠðî£ó¼‚° G¬ù׆´‚ è®î‹ 㶋 ÜŠðŠðìñ£†ì£¶. 7. M‡íŠðŠ ð®õˆF¡ ¹¬èŠðì ïè™ ãŸÁ‚ ªè£œ÷Šðìñ£†ì£¶. °PŠ¹ : 1. Þ‰îŠ ð®õ‹ ñîñ£Ÿø‹ ܶ ªî£ì˜ð£ù ªðò˜ ñ£Ÿøº‹ ªõOJì ñ†´«ñ ðò¡ð´ˆî‚îò‹. ªðò˜ ñ£Ÿø‹ ñ†´«ñ ªêŒò M¼‹¹«õ£˜ Ü‡ì£ù îQŠ ð®õˆF¬ù (Proforma-I) M‡íŠð‹ ªêŒ¶ ªðŸÁ ªðò˜ ñ£Ÿø‹ ªêŒòô£‹. 2. ñîñ£ŸøˆFŸ°Kò Ýî£óñ£è ñîˆFŸ° ªð£ÁŠH™ àœ÷ ñîˆî¬ôõ˜è÷£™ ñ†´«ñ õöƒèŠð†ì Üê™ ê£¡Pî› Ü™ô¶ ꣡Á¬ó‚èŠð†ì ïè¬ô Þšõ½õôèˆF¡ 𣘬õ‚è£è ÞŠð®õˆ¶ì¡ ެ툶 ÜŠð «õ‡´‹.

This Proforma is intended for the Change of Name and Religion only INSTRUCTIONS 1. The application and the notice for change of name, etc., must be from the person who wishes the name to be changed duly signed by him with a witness from an “A” or “B” Grade Officer of Tamil Nadu Government/Central Government not related to the applicant and should contain his/her address and no correspondence will be entered into with any other person than the person who wishes his/her name to be changed. The present name (Old name) and signature are to be identical. 2. In the case of minors whose name is to be changed, the parent or guardian (if parent deceased) should sign the notice for change of name. He/She should write the name in capitals below the signature and also mention the relationship with the individual who changes the name and religion. 3. Notice for a change of name and religion will be entertained only in respect of persons who are natives of this State for which they should give a declaration in the notice. There should be no correction in the notice. 4. The charges for publication of change of name and religion including the cost of five copies of Gazettes and postage charges are Rs. 415/-. The same may be paid either at Cash Counter of this office between 10.00 am. to 1.00 p.m. and 2.00 p.m. to 3.00 p.m. or sent to the Assistant Director (Publications), Commissionerate of Stationery and Printing, 110, Anna Salai, Chennai-600 002 in the form of

Demand Draft drawn in any nationalised bank in favour of the Assistant Director (Publications), Commissionerate of Stationery and Printing, 110, Anna Salai, Chennai-600 002. Publication charges by means of Money Orders and Postal Orders will not be accepted. 5. Five copies of Gazettes in which the change of name, etc., was published will be sent to the concerned person by Registered Post. Any more copies required will have to be purchased by the person from the Assistant Director (Publications), Commissionerate of Stationery and Printing, 110, Anna Salai, Chennai-600 002 on separate payment. 6. No reminders to the party either for remittance or for any other particulars will be sent. 7. Xerox copy of the Proforma will not be accepted. Note: (1) This Proforma is intended to publish the change of name together with the change of one religion to another religion. If the party desires to publish the change of name only, a separate Proforma (Proforma-I) is available and will be sent on application. (2) The original religious reconversion certificate issued by the religious authority or a certified copy of it should be sent with this proforma for the reference of this office.