La Gazette de L' État de Poudouchéry
The Gazette of Puducherry
Publiée par Autorité
Published by Authority
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SOMMAIRES
CONTENTS
Page
Page
.. 1220
Sentence arbitral du travail
.. 1220
Award of the Labour Court .. 1220
de tribunal.
.. 1226
Notifications du Gouvernement .. 1226
Government Notifications .. 1226
.. 1227
Avis d’Adjudications
.. 1227
Tender notices
.. 1227
.. 1228
Etablissements dangereux
.. 1228
Dangerous Establishments
.. 1228
.. 1231
Annonces
.. 1231
Announcements
.. 1231
[1219]
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Dated : 7-11-2017
Price : ` 14-00
2017 }
|
7 {
No.
45
Poudouchéry
Mardi
7
Novembre
2017 (16 Kartika 1939)
No.
Puducherry
Tuesday
7th
November
2017
1231
7 November 2017]
LA GAZETTE DE L’ETAT
Sl.
Name and address
Address of the
Industry
Power
No. of
No.
of the applicant
industry site
proposed
required
workers
(1)
(2)
(3)
(4)
(5)
(6)
Thiru/Tmt./Selvi:
1
C. Kevin Sadjiv,
M/s. Atslaha Ind,
Non Woven bags
15 H.P.
10
Partner,
Re-survey No. 2,
and cotton bags.
(Shift-I).
No. 10, Caron Street,
Plot Nos. 11 and 12,
Puducherry-605 001.
Door No. 202,
CAD No. 3,
Kurumbapet,
Villianur Commune Panchayat,
Puducherry.
2
A. Asif Shaik Mohideen,
M/s. ASM Industries,
Disposable plastic
128 H.P.
8
No. 21, 1st Cross,
Plot No. A-72,
cups.
(Shift-I).
Rainbow Nagar,
PIPDIC Industrial Estate,
Puducherry-605 011.
Sedarapet,
Villianur Commune Panchayat,
Puducherry.
In conformity with rule 11 of the Puducherry Commune Panchayats (Grant of Licences and Permissions)
Rules, 1976, promulgated in this Union Territory by the Puducherry Village and Commune Panchayats Act, 1973,
objections, if any, to the setting up of the above industries are invited to reach the Commissioner, within ten
days from the date of publication of this notice in the Official Gazette.
The objections so received within the specified period will be considered by the Villianur Commune
Panchayat.
D. ARUMUGAM,
Commissioner.
AFFIDAVIT
I, Karthik alias Nallasivam, son of Viswanathan,
Hindu by religion, aged 24 years and residing at the
house bearing Door No. 10, Vallalar Street, Nagammal
Nagar, Karuvadikuppam, Puducherry-605 008, do
hereby solemnly and sincerely affirm to whomsoever
it may concern as follows:
I am the deponent herein. I state that in my
Certificate of Birth issued by the Pondicherry
Municipality registered under Registration No. M/
1993/09833 and in my Electoral Identity Card
under No. ATT0043414 issued by the Election
Commission of India, my name has been mentioned
as ‘Karthik @ Nallasivam’.
In my Transfer Certificate issued by the
Principal, Fatima Higher Secondary School under
Admission No. 4491, my name has been mentioned
as ‘Karthik @ Nallasivam.V’.
In my Aadhaar Card under No. 5446 9331 3194,
my name has been mentioned as ‘V.Karthik alias
Nallasivam.’
In my Driving Licence under No. PY01
20130010950 issued by the Assistant Licensing
Authority, Puducherry, my name has been mentioned
as ‘Karthik alias Nallasiva M’.
In my Family Ration Card under No. 055124
issued by the Department of Civil Supplies and
Consumer Affairs, Puducherry, my name has been
mentioned as ‘’.
Therefore, I do hereby state that all the
abovesaid names are refer, identify and relate to one
and the same person that is myself the deponent
herein. Hereafter, I shall be known and identified only
by the name ‘Karthik Nallasivam ()’
for all purposes.
1232
LA GAZETTE DE L’ETAT
[7 November 2017
I state that what are all stated in the above paragraphs
is true and correct to the best of my knowledge,
belief and information.
Solemnly and sincerely affirmed and signed before
the Notary Public at Puducherry on this 17th day of
October 2017.
53990
V. KARTHIK.
————
AFFIDAVIT
I, K. Ammamuthu, wife of Kuzhanthaivel, aged about
32 years, residing at No. 26, Perumal Koil Street,
Karaikalmedu, Karaikal, do hereby solemnly declare
and state on oath as follows:
I hereby state that my name is ‘Ammamuthu’ and
the same is mentioned in my Birth Certificate
issued by the Kottucherry Commune Panchayat,
Kottucherry vide Registration No. 159, date of
Registration 10-6-1985, my name is mentioned as
‘Ammamuthu’ and in my Marriage Certificate issued
by the Karaikal Municipality, Karaikal
vide
Registration No. 419DM/2010, dated 2-11-2010,
my name is mentioned as ‘Ammamuthu’, in my
Aadhaar Card vide Card No. 4650 4004 4884
issued by the Government of India, my name is
mentioned as ‘Ammamuthu ()’, whereas,
my name is mentioned as ‘’ in our Family
Ration Card issued by the Department of Civil
Supplies and Consumer Affairs, Karaikal vide
Sl. No. 194357.
I declare that henceforth, I will be called, known
and sign my name as ‘Ammamuthu’ only. Hence, this
affidavit is made to prove my change of name.
The above particulars are true to the best of
my knowledge, belief and trust, and nothing has been
concealed thereon.
Solemnly affirmed
and
signed
before the Notary
Public at Karaikal, on this 20th day of October 2017.
53996
K. .
————
AFFIDAVIT
I, S. Dhananjayan, son of Sinuvasan, aged 46 years,
residing at No. 47, 3rd Cross Street, Lakshmi Nagar,
Chinnayan pet, Saram Post, Puducherry-605 013, do
hereby solemnly affirm and sincerely state on oath
as follows:
That I am the deponent herein and I know all
this facts of my deposition well.
I submit to state that my name is mentioned
as ‘Dhananjeyan’ in my son Eyuvaraj’s
Birth Certificate issued by the Pondicherry
Municipality vide Registration No. M/2003/
03999, dated 3-4-2003.
I submit to state that my name is mentioned
as ‘Dhananjayan’ in my another son Sabharish
Srinivas’s Birth Certificate issued by the
P
o
n
d
i
c
h
e
r
r
y
Municipality, vide Registration
No. M/2004/03695, dated 5-4-2004.
I submit to state that my name is mentioned
as ‘Dhananjayan’, in my Aadhaar Card issued
by the Unique Identification Authority of India,
vide No. 8571 2043 0821.
I submit to state that my name is mentioned
as ‘Dhananjayan’ in my Elector’s Photo
Identity
Card
issued
by
the
Election
Commission of India, vide No. GKY0633404.
I submit to state that my name is mentioned
as ‘Dhananjayan’ in my son Eyuvaraj’s Aadhaar
Card issued by the Unique Identification
Authority of India, vide No. 3305 2700 5028.
I submit to state that my name is mentioned
as ‘Dhananjayan S’ in my Savings Account
Passbook issued by the Union Bank of India,
Puducherry vide Account No. 379502010006217.
I declare and state that the above names
‘Dhananjeyan’, ‘Dhananjayan’ and ‘Dhananjayan S’
are refer to one and the same person they denote
me i.e., myself only.
Henceforth, I will be called and known as
‘Dhananjayan’ only.
The above deposition is true and correct to the
best of my knowledge and belief.
Signed before the Notary Public at Puducherry, on
this 24th day of October 2017.
53997
S. DHANANJAYAN.
————
(Mari)
—
1233
7 November 2017]
LA GAZETTE DE L’ETAT
P
‘Jeanine Suzanne Augustine’
‘(Jeanine Suzanne Augustine)’
PY‘(Mari)’
359275
‘’ Madheen
Arokiadass, Rajesh
‘Mary’
‘Jeanine Suzanne Augustine)’
————
AFFIDAVIT
I, Kunwar Kamal Bhaii, son of Ramakanta Mallik
(late), Hindu, aged about 44 years and residing at
Bhaii’s Mission Ashram, Eternal House, No. 34, Goubert
Padasalai Street, Vazhaikulam, Puducherry-605 003,
do hereby solemnly affirm and declare as follows:
I state that I am the deponent herein and I am well
aware of the facts of this deposition.
I state that my name has been mentioned as
‘Kunwar Kamal Bhaii’ in the following documents.
1. In my Aadhaar Card No. 7146 3189 1701
issued by the Unique Identification Authority of
India.
2. In
my
Elector’s
Photo
Identity
Card
No.
HJN0211466
issued
by
the
Election
Commission of India.
3. In my PAN Card No. ALKPB5525A issued
by the Income Tax Department, Government of
India.
4. In the Trust Deed registered in the name
‘Bhaii’s Mission Ashram’ registered at the
Sub-Registrar
Office,
Puducherry
under
Registration No. 255/2006, dated 16-3-2006.
5. In my Indian Passport No. G6929850 issued
by the Regional Passport Office, Chennai.
I state that my name is entered as ‘’
in our Family Ration Card No. 154142 issued by
the Department of Civil Supplies and Consumer
Affairs, Puducherry.
I state that now, I have changed my name as
‘Shreemad Maharshi Shri Shri Kamal Mahaprabhu’
instead of ‘Kunwar Kamal Bhaii’ and I do not
possess any evidence for the documentary proof in
support of my changed name.
I state that the abovesaid names as ‘Shreemad
Maharshi Shri Shri Kamal Mahaprabhu’, and
‘Kunwar Kamal Bhaii’ are refer to one and the same
person, i.e., myself only.
I state that I made this affidavit in lieu proof of
identity of my adopted name as ‘Shreemad
Maharshi Shri Shri Kamal Mahaprabhu’.
I take oath and solemnly declare/affirm that the
particulars furnished by me above are correct and
that I have not concealed or misrepresented any
facts.
Solemnly affirmed and signed before the Notary Public
at Puducherry, on this 23rd day of October 2017.
54000
KUNWAR KAMAL BHAII
————
,,
,,
(Panchavarnam
alias Ruth)
‘(Panchavarnam)’
,PY/
01/020/087282-‘(Panjavarnam)’
,
‘’,
‘G.
’
,
1234
LA GAZETTE DE L’ETAT
[7 November 2017
‘Panchavarnam. G. Ruth’
‘’
‘(Panchavarnam alias Ruth)’
,
.
————
AFFIDAVIT
I, Ganapathy, son of Ranganathan, Hindu, aged 45 years,
residing at No. 3, 1st Cross Street, Sivagami Nagar,
Kottaimedu, Ariyankuppam, Puducherry-605 007
do hereby solemnly and sincerely affirm and state as
follows:
I am the deponent herein and I am well aware of
the facts of my deposition.
I state that in my Aadhaar Card, Voter’s Identity
Card, in my daughter’s Birth Certificate and in
my son’s Birth Certificate, my name is mentioned
as ‘Ganapathy’.
I state that in my Birth Certificate, my name is
mentioned as ‘Peroumal’.
I solemnly affirm and declare that the names
‘Ganapathy’ and ‘Peroumal’ are refer to one and the
same person that is myself only. Hereinafter, I shall
be called by the name ‘Ganapathy @ Peroumal’.
I state that what are all stated above is true to the
best of my knowledge, belief and information, and
nothing material facts have been suppressed herein.
Solemnly and sincerely affirmed and signed before
the Notary Public at Puducherry, on this 24th day of
October 2017.
113005
R. GANAPATHY.
AFFIDAVIT
I, Anuradha Barath, daughter of Chandran, wife of
Barath, aged 39 years, residing at No. 7, Millennium
Street, Bharathi Mill Ro ad,
Mudaliarpet,
Puducherry-605 004, do hereby solemnly declare and
affirm on oath as follows:
I state that I am the deponent herein and I am
well aware of the facts of this deposition.
I state that my name has been mentioned as
‘Anuradha’ and the surname as ‘Barath’ in my British
Passport No. 307926548 issued by the United
Kingdom of Great Britain and Northern Ireland.
I state that my name has been entered as
‘Anuradha’, daughter of Chandran in the following
documents:
1. In my Birth Certificate under Registration No.
P/1978/1870, dated 1-4-1978 issued by the
Pondicherry Municipality, Puducherry.
2. In my Aadhaar Card No. 5849 3469 8765
issued by the Unique Identification Authority of India.
3. In my PAN Card No. BMPPA2114P issued by
the Income Tax Department, Government of India.
4. In
my
Voter’s
Identity
Card
No.
DNX0403899, dated 24-3-2001.
Further, I state that in my B.Sc. Degree Certificate
issued by the Pondicherry University, Puducherry,
my name is mentioned as ‘Anurada. C’.
I do hereby declare that all the above names
‘Anuradha surname Barath’, ‘Anuradha’, daughter of
Chandran and ‘Anurada. C’ are denote one and the
same person i.e., myself only.
Further, I state that my correct name and my
name henceforth be known as ‘Anuradha surname
Barath’ only.
I am making this affidavit to publish my correct
name as ‘Anuradha surname Barath’.
I take oath and solemnly declare/affirm that the
particulars furnished by me above are correct and
that I have not concealed or misrepresented any facts.
Solemnly affirmed and signed before the Notary Public
at Puducherry, on this 24th day of October 2017.
113006
ANURADHA BARATH.
————
CHANGE OF RELIGION
I, Santhi, daughter of Krishnamoorthy, Indian, aged
about 43 years, residing at No. 50, Beach Road,
Bharathi Nagar, First Cross, Karaikal, do hereby
solemnly affirm and sincerely state as follows:
1235
7 November 2017]
LA GAZETTE DE L’ETAT
I am a Hindu by birth. My birth name was
‘Santhi’. I had renounced my religion of birth and
embraced Islam. Pursuant to conversion, I have
changed my name as ‘Saaliha ()’.
I hereby declare that I relinquish and give up
my birth name ‘Santhi’ and I shall henceforth be
known, called, referred and identified only as
‘Saaliha ()’.
Solemnly affirmed and signed before the Notary
Public at Karaikal, on this 24th day of October 2017.
113010
K. SANTHI.
————
AFFIDAVIT
I, Ramesh Babu. C. P., Son of Kunhi Raman.C.P,
aged 61 years, residing at 5/263, Chelleth House,
Manjakkal, Mahe, do hereby solemnly affirm and
state as follows:
1. I swear and state that my father Kunhi
Raman.C.P. holder of Livert De Famille (Family
Book) No. 29, issued by the Mahe Municipality,
Mahe. In French, my father’s name is entered as
‘Cougn Parambette Pohil Cougnyramin’.
2. I swear and state that in my Secondary School
Leaving Certificate vide Register Nos. 3085 of
1972 March/September and 28201 of 1972 April/
September issued by the Board of Public
Examinations, Kerala, my father’s name is entered
as ‘Kunhiraman.C.P.’.
3. I swear and state that I am the holder of PAN
Card vide No. AADPC3272D, my father’s name is
entered as ‘C.P.C. Raman’.
4. I state and declare that the above-mentioned
names recorded in the said documents are refer,
identify and denote one and the same person that
is my father only.
5. I swear and state that my father’s correct
name is ‘Kunhi Raman.C.P.’. Therefore, I swear
this affidavit, for knowledge of my relatives,
friends, officials concerned and others that
hereinafter, he will be known only as ‘Kunhi
Raman.C.P’ for all purposes and intends after the
publication in the Gazette.
All this is true.
Solemnly affirmed and signed before the Notary Public
at Mahe, on this 18th day of October 2017 at Mahe.
113012
RAMESH BABU. C.P.
AFFIDAVIT
I, Jayachithra, daughter of Magalingame and wife of
Sundaramoorthy, aged 42 years and residing at the
house bearing Door No. 2, East Street, Pettai,
Thirunallar, Karaikal-609 607, do hereby solemnly and
sincerely affirm to whomsoever it may concern as
follows:
I am the deponent herein.
I state that in my Certificate of Birth registered
with the Thirunallar Commune Panchayat under
Registration No. T/1975/223, my name has been
mentioned as ‘Djea’.
In my Transfer Certificate under Admission No.1715,
issued by the Principal, Government Girls’ Higher
Secondary School, Thirunallar, my name has been
mentioned as ‘Djea.M’.
In my Marriage Certificate under No. 5400/2001 A3,
my name has been mentioned as ‘S. Jayachitra’.
In
my
Electoral
Identity
Card
under
No. GWQ0235903, my name has been mentioned
as ‘Jaya ()’.
In my Aadhaar Card under No. 7180 0678 3943,
my name has been mentioned as ‘Jaya. S ()’.
In my husband Sundaramoorthy’s Serving Certificate,
my name has been mentioned as ‘M. Chitra’.
In my elder son Anandhakumar’s Certificate of
Birth registered under Registration No. T/1995/176,
my name has been mentioned as ‘Jayachitra’.
In my younger son Subash Chandrabose’s
Certificate of Birth under Registration No.5, my
name has been mentioned as ‘S. ’.
In my Family Ration Card under No. 219063,
my name has been mentioned as ‘’.
I state that all the abovesaid names are refer,
identify and relate to one and the same person that
is myself the deponent herein.
Hereafter, I shall be known and identified only by
the name as ‘S. Chitra ()’ for all purposes.
I state that what are all stated in the above
paragraphs is true and correct to the best of
my knowledge, belief and information.
Solemnly and sincerely affirmed and signed before
the Notary Public at Puducherry, on this 24th day of
October 2017.
113013
S. .
1236
LA GAZETTE DE L’ETAT
[7 November 2017
AFFIDAVIT
I, Gowdham Ram, son of Gopalakrishnan, aged 21
years, Hindu, Indian, residing at No. 29, Agraharam
Street, Sethur, Karaikal, Union territory of Puducherry,
do hereby solemnly affirm and sincerely state on oath
as follows:
I am the deponent herein and I am very well
aware of my deposition.
I swear that I was born on 17-3-1996 which has
been duly registered under Registration No. K/
1996/00717
in the Karaikal
Municipality
in which
my name has been recorded as
‘Gowdham Ram’ as
well as in my Elector ’s
Photo Identity Card No. UR10078444 issued by
the Election Commission of India, in my Aadhaar
Card No. 3075 9552 9310 issued by the Unique
Identification Authority of India, in my Driving
Licence No. PY02 20150001248 issued by the
Transport Authority, Karaikal and in my Educational
Records, such as in my Provisional Certificate,
Folio No. AUU1017040 issued by the Anna
University, Chennai and in my Transfer-cum-
Conduct Certificate Folio No. 4827 issued by the
DSCET College and whereas, my name has been
recorded as ‘’ in my Family Ration Card
No. 205799 issued by the Department of Civil
Supplies and Consumer Affairs, Karaikal. Hence,
the names ‘Gowdham Ram’ and ‘’ are refer
to and denote one and the same person i.e., myself. Now,
I intend to change my name as ‘Vinay Gowtham
Raam’ due to my personal accord and decision.
Hereafter, I will be called as ‘Vinay Gowtham Raam’
only.
All the contents of the affidavit are correct, true
and best of my knowledge, belief and information,
and I have not concealed or misrepresented any facts.
Solemnly affirmed and signed before the Notary Public
at Karaikal, on this 23rd day of October 2017.
113014
G. GOWDHAM RAM.
————
AFFIDAVIT
I, Subiidha Rangham, daughter of Ranga Sudhakar,
aged 38 years and residing at the house bearing Door
No.
34,
Sixth
Cross
Street,
Jawahar
Nagar,
Boomianpet, Nellithope, Puducherry-605 005, do
hereby solemnly and sincerely affirm to whomsoever
it may concern as follows:
I am the deponent herein. I swear this affirmation
on behalf of my minor daughter ‘Miithrra Mohan’.
I state that in the Certificate of Birth of
my daughter issued by the Greater Chennai
Corporation registered under Registration No.
COC/2003/07/109/000644/0, her name has been
mentioned as ‘Nikita Deshmukh’.
In the Transfer Certificate under Admission
No. 210314 issued by the Principal, St. Patrick
Matriculation Higher Secondary School, Puducherry
and in the Aadhaar Card under No. 2819 5394 4522
issued by the Unique Identification Authority of
India, her name has been mentioned as ‘Miithrra
Mohan’.
In the Family Ration Card under No. 132588,
issued by the Department of Civil Supplies and
Consumer Affairs, Puducherry, her name has been
mentioned as ‘’.
Therefore, I do hereby state that the said names
‘Nikita Deshmukh’, ‘Miithrra Mohan’ and ‘
’ are refer, identify and relate to one and the
same person that is my said minor daughter only.
I state that hereafter, my daughter shall be known
and identified only by the name ‘Miithrra Mohan’
for all purposes.
I state that what are all stated in the above
paragraphs is true and correct to the best of
my knowledge, belief and information.
Solemnly and sincerely affirmed and signed before
the Notary Public at Puducherry, on this the 26th day
of October 2017.
113015
SUBIIDHA RANGHAM.
————
Sivasakthi
M/
‘Sivasakthi’
TLS
‘Sivasakthi’
‘Sivasakthi’
‘’
1237
7 November 2017]
LA GAZETTE DE L’ETAT
‘(Sivasakthi)’
30
113021
S. SIVASAKTHI.
————
,,
,,
(A. Antoine Kittery)
M/1983/
02835
‘Antoine Kittery’,
‘Antoine Kittery. A’
‘
(A. Antoine Kittery)’,
HKD0312025‘
(Antoine Kittery)’
‘’
‘
(A. Antoine Kittery)’
,
A..
AFFIDAVIT
I, Ejoumale, son of Sinnathambi, Hindu, aged
about 59 years, residing at No. 35, New Street,
Sanarapet, Mutharayarpalayam, Puducherry-605 009,
do hereby solemnly affirm and state as follows:
I am the deponent herein.
I state and declare that I was born at Puducherry
and my birth was duly registered before the
Competent Authority of Puducherry and at the time
of birth, I had been named as ‘Ejoumale’ and the name is
e n t e r e d s u c h a s i n my B i r t h C e r t i f i c a t e .
(Registration No. 0/1957/00606, dated 16-11-1957).
Whereas, in my Service Record, my name is spelled
as ‘Elumalai’ and in my Aadhaar Card, my name is
mentioned as ‘Ezhumalai’. (No. 8628 4032 3909).
In the Voter’s Identity Card, it is mentioned as
‘Ezhumalai’ (No. PY/01/019/009454), my name is
mentioned as ‘’ in my Family Ration Card
No. 43579.
Therefore, I swear and affirm that the said
my name with different spellings are ‘Ezhumalai’,
‘Ejoumale’, ‘Elumalai and ‘’ are referring
one and the same person i.e., myself and not any
other person. Thus, I am executing this affidavit in
this regard, I have not concealed any real facts.
I state that hereafter, I shall be known and
identified only by the name ‘Ezhumalai ()’
for all purposes.
Solemnly affirmed and signed before the Notary
Public at Puducherry, on this 30th day of October 2017.
113024
S. ELUMALAI.
————
AFFIDAVIT
I, Mathivathani, wife of Murugaiyan, residing at
No. 6, 3rd Cross Street, Rainbow Nagar, Nonankuppam,
Ariyankuppam Commune Panchayat, Puducherry-605 007,
do hereby solemnly affirm and sincerely state on oath
as follows:
That I am the deponent herein and I know all this
facts of my deposition well.
I submit to state that my name is mentioned as
‘Madivadani’ in my Birth Certificate issued by
Bahour Commune Panchayat, Bahour, Puducherry
vide Registration No. 381, dated 7-11-1977.
I submit to state that my name is mentioned as
‘Mathivathani’in my Electoral Identity Card issued
by Election Commission of India vide Card
No. PY/01/013/000602 and in my Aadhaar Card
issued by Unique Identification Authority of India
vide Card No. 7593 2970 5591.
1238
LA GAZETTE DE L’ETAT
[7 November 2017
No legal responsibility is accepted for the publication of advertisement regarding change of names and other private notifications
in the Gazette. Persons notifying the same will remain solely responsible for the legal consequences and also for any other
misrepresentations, etc.
online publication at “http://styandptg.puducherry.gov.in”
Government Central Press
Directorate of Stationery and Printing
Puducherry-605 009
I submit to state that my name is mentioned as
‘’ (in Tamil) in my Family Ration Card issued
by Department of Civil Supplies and Consumer
Affairs, Puducherry, vide Card No. 317427.
The above-mentioned names ‘Madivadani’,
‘Mathivathani’ and ‘’ are one and the same
person i.e., myself only.
Further, I declare that I may be called only
as ‘Mathivathani’in future.
I take oath and solemnly declare/affirm that the
above information furnished by me is correct and
that I have not concealed or misrepresented any
facts on the above matter.
Signed before the Notary Public at Puducherry,
on this 31st day of October 2017.
113027
M. MATHIVATHANI.
————
AFFIDAVIT
I, Nazera Begam, wife of Abdul Suban, aged
37 years and residing at No. 27, Arun Shangar Nagar,
Annusamy Vaikal Street, Karaikal-609 602, Puducherry
State, do hereby solemnly affirm and state as follows:
1. I am swearing this affirmation for and on
behalf of my son ‘Fackurudeen Ali Ahamed’ who
is minor, aged 17 years. I am the natural guardian
of ‘Fackurudeen Ali Ahamed’.
2. I swear and state that in my son’s Birth
Certificate issued by the Registrar of Births
and Deaths, Pondicherry Municipality
vide
Certificate Registration No. C/2000/00295, his
name is entered as ‘Fackurudeen Ali Ahamed’.
3. I swear and state that in my son’s Aadhaar
Card No. 2496 4151 7012, his name is entered
as ‘Fackurudeen Ali Ahamed’ issued by the
Unique Identification Authority of India.
4. I swear and state that in my son’s Secondary
School Examination
vide Roll No. 5001960
issued by the Department of Government
Examinations, Chennai, his name is entered as
‘Fackurudeen Ali Ahamed A’.
5. I swear and state that in my son’s Transfer
Certificate, Serial No. H008/20174 issued by
St. Marys Higher Secondary School, Karaikal, his
name is entered as ‘Fackurudeen Ali Ahamed. A’.
6. I swear and state that in my son’s Higher
S e c o n d a r y S c h o o l E x a mi n a t i o n v i d e R o l l
No. 596820 issued by the Department of
Government Examinations, Chennai, his name is
entered as ‘Fackurudeen Ali Ahamed A’.
7. I swear and state that in my Family Ration
Card vide No. 211980 issued by the Department
of Civil Supplies and Consumer Affairs, Karaikal,
my son’s name is entered as ‘’.
8. I swear and state that I intent to change
my son’s name as ‘A. Bakrudeen Ali Ahamed
(A.’.Therefore, I swear this
affidavit for knowledge of my relatives, friends,
officials concerned and others. Hereinafter, my
son will be known only as ‘A. Bakrudeen Ali
Ahamed (A.’ in all purpose
and intends after the publication of the Official
Gazette of Puducherry.
9. I state that what are all stated in the above
paragraphs is true and correct to the best of
my knowledge, belief and information.
Solemnly affirmed and signed before the Notary Public
at Karaikal, on this 21st day of September, 2017.
Ack. No. 429