Example Statutory Declaration For Change Of Name Form printable pdf download

Example Statutory Declaration For Change Of Name Form

Example Statutory Declaration for Change of Name

I [insert full new name] formerly known as [insert full old name]

and permanently residing at [insert full home address]

do solemnly and sincerely declare that:

1. I absolutely and entirely renounce, relinquish and abandon the use of my former

name of [insert full old name]and assume, adopt and determine to take and use from

the date hereof the name of [insert full new name] in substitution for my former name

of [insert full old name];

2. I shall at all times hereafter in all records, deeds and other writings and in all

actions and proceedings, as in all dealings and transactions and on all occasions

whatsoever, use and subscribe the said name of [insert full new name] as my name

in substitution for my former name of [insert full old name] so relinquished as

aforesaid to the intent that I may hereafter be called, known or distinguished not by

the former name of [insert full old name] but by the name of [insert full new

name] only;

3. I authorise and require all persons at all times to designate, describe and address

me by the name of [insert full new name];

AND I make this solemn declaration conscientiously believing the same to be true

and by virtue of the provisions of the Statutory Declarations Act 1835.

Declared at _________________ on this __ day of ______ 20____ before

_________________, a solicitor/notary public/other officer of the court empowered

to administer oaths.

Signed: _______________________ [insert full new name]

(Former signature of former name: ____________________)

Signature of person administering oath: ________________________________

Name of person administering oath:____________________________________

Address of person administering oath:__________________________________

Example Statutory Declaration For Change Of Name Form