I, Kavita Vashista W/o Dhiraj Kumar Vashista, R/o House No.748/21, Street No.02, Om Nagar, Khandsa Road, Gurgaon, do hereby declare that my correct name is Kavita Vashista, and in LIC Policy No.333371899 it was wrongly written as Kavita Sharma. Both names refer to the same person. State: Haryana