DEED OF CHANGE OF NAME (CHANGE OF NAME DEED POLL)
THIS DEED OF CHANGE OF NAME is made by way of deed poll on ________
BY
(1) ________, formerly known as ________, of ________ (the "Declarant").
BACKGROUND
(A) The Declarant has determined to abandon and renounce the use of their former name and to assume and use a new name for all purposes.
(B) The Declarant makes this Deed Poll in order to record that change of name and to provide evidence of it under the law of England and Wales.
THIS DEED DECLARES as follows:
§ 1. PERSONAL DETAILS
1.1 The Declarant was born on ________ at ________.
1.2 The Declarant's gender is ________.
1.3 The Declarant's current relationship status is ________.
§ 2. NATIONALITY AND IMMIGRATION STATUS
2.1 The Declarant confirms that their nationality is ________.
2.2 To the extent applicable, the Declarant is a British citizen within the meaning of the British Nationality Act 1981.
§ 3. FORMER NAME
3.1 Immediately before the date of this Deed, the Declarant was known by the name ________ (the "Former Name").
§ 4. RENUNCIATION OF FORMER NAME
4.1 The Declarant absolutely and entirely renounces, relinquishes and abandons the use of the Former Name and wholly ceases to use or be known by that name.
4.2 The Declarant assumes, adopts and determines to use in place of the Former Name the name ________ (the "New Name") with immediate effect.
§ 5. USE OF NEW NAME
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§ 6. AUTHORITY FOR THIRD PARTIES
6.1 The Declarant authorises and requires all persons, bodies, organisations and authorities at all times to designate, describe, address and refer to the Declarant by the New Name only.
§ 7. EVIDENCE OF CHANGE OF NAME
7.1 This Deed Poll shall be conclusive evidence of the Declarant's change of name and may be produced as such to any person, body, organisation or authority requiring evidence of the change.
§ 8. GOVERNING LAW
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§ 9. EXECUTION
9.1 The Declarant intends this document to take effect as a deed and has executed it as a deed, delivering it on the date set out above.
EXECUTED AS A DEED by ________, formerly known as ________:
Signed (in the New Name):..............................................
________
formerly known as
Signed (in the Former Name):..............................................
________
IN THE PRESENCE OF:
Signature of witness:..............................................
Full name of witness: ________
Address of witness: ________
Occupation of witness: ________
Date of witnessing: ________