Sample Affidavit for One and The Same Person for U.S. Immigration



I, the undersigned, Mrs. JADAV Smita Dipesh, aged 42 years, Hindu by religion, residing at 35 Nijanand Society, Kuber Nagar, Ahmedabad 380 052, India, do hereby solemnly affirm and declare on oath that:

  1. I am the deponent herein and a citizen of India. 

  2. I was born on Dec. 17, 1977, in Bikaner, Rajasthan, India.

  3. My birth name is BHATT Smita Jaydevbhai. 

  4. It is customary in our region to add the suffix “-ben” for female first names for showing respect, while it is customary to add suffixes, such as “-chandra”, “-bhai, “-kumar”, “-lal”, etc. for male first names. This is similar to putting Mr., Mrs., Ms., etc. in front of names in the U.S.

  5. Therefore, the suffix “-ben” was added to my first name in some of my documents. My father’s first name was used as my middle name in some of my documents. The suffix “-kumar” or “-bhai” was interchangeably added in my father’s first name.

  6. I was married to JADAV Dipesh Morarilal on Apr 2, 1992, in Ahmedabad, Gujarat, India.

  7. After marriage, I changed my name to JADAV Smita Dipesh. 

  8. Therefore, the following names refer to the one and the same person: 
    BHATT Smita
    BHATT Smita Jaydevbhai
    BHATT Smita Jaydevkumar
    BHATT Smitaben Jaydevbhai
    BHATT Smitaben Jaydevkumar
    JADAV Smita Dipesh

    The above are the variations of the same name and should not be considered name changes.

So I do hereby solemnly affirm that the foregoing are true and correct statements.

Place: Ahmedabad, Gujarat, India
Date: May 30, 2019


Note: The above affidavit is just a sample. The Microsoft Word template below has been provided solely as a formatting template and is formatted in such a way that you can directly print onto the standard stamp paper used in India so that you don’t have to go through the hassle of a manual typewriter. It is not for filling in the blanks because your situation will vary.

You should modify the wording accordingly and make your own document. Different sample affidavits on this website by different relatives try to cover a few different scenarios. Therefore, the sample affidavits for the same person vary. However, you should try to make consistent affidavits for your particular case.

Word doc

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For visitors, travel, student and other international travel medical insurance.

Visit or call +1 (866) INSUBUY or +1 (972) 985-4400