AFFIDAVIT FOR CHANGE OF NAME AND GENDER

I, <Old Name> (Old Name), child of <Parent Name>, aged <Parent age> years, presently residing at <address>, do hereby solemnly affirm and declare as follows:

1.I am currently residing in the aforementioned address.

2.I wholly relinquish and abandon the use of my former name, <Old Name> and in its place, I hereby assume <New Name> effective from this date.

3.For the purpose of evidencing such, my determination declare that I shall at all times hereafter in all records, deeds and writings and in all proceedings, dealings and transactions, private as well as upon all occasions whatsoever, use and sign the name <New Name> as my name/surname in place of my former name.

4.I expressly authorize and request all persons in general, relatives and friends in particular, at all times hereafter to designate and address me by such assumed name/surname <New Name>.

5.I perceive myself as <Gender> person whose gender does not align with the gender assigned at birth.

6.That I declare myself as <Gender>.

7.That I am executing this affidavit to be submitted to the District Magistrate for issue of certificate of identity as <Gender> under Section 7 of the Transgender Persons (Protection of Rights) Act, 2019 read with Transgender Persons (Protection of Rights) Rules, 2020.

8.I affirm that my decision to change my name and gender is voluntary and made without any coercion or undue influence from any individual or entity.

9.I have undertaken psychological counselling and introspection to ascertain my gender identity, and after careful consideration, I affirm that my chosen gender aligns with my true identity.

10.I am undergoing Hormone Replacement Therapy under the supervision of a qualified Endocrinologist Dr.<Doc Name> at <Hospital or Clinic address>, as part of my Gender Transition from <Old Gender> to <New Gender>, affirming my determination to align my physical characteristics with my gender identity.

11.My Decision to undergo Hormone Replacement Therapy is based on a thorough and comprehensive understanding of the potential risks, benefits, and effects. It reflects/validates my gender identity and alleviates my gender dysphoria.

12.I understand the legal implications of changing my name and gender and accept the responsibilities associated with maintaining accurate records and documentation reflecting my identity.

VERIFICATION

I, <New Name>, hereby declare that whatever is stated herein from Serial No. 1 to 12 are true to the best of my knowledge and belief.

Date :
Place :

<New Name Signature>
<New Name>
DEPONENT

Identified by: <Notary Advocate Space