Deed poll
CHANGE OF NAME DEED intended for enrolling in the
Central Office of the Senior Courts of England and Wales
Date the deed is made
D D
/
M M
/
Y Y Y Y
Your new name in full
Your address
Your old name
Single Married/Civil Partnership
Widowed Divorced/Civil Partnership dissolved
Status
British Citizen British Dependent Territories Citizen
Commonwealth Citizen
Under section of the British Nationality Act 1981
WITNESSES AND IT IS
HEREBY DECLARED
I ABSOLUTELY
at all times from this date in all records documents and other writings and in all actions and
proceedings as well as in all dealings and transactions and on all occasions use my new name in
substitution for my old name. I
and my wife and my husband
and my civil partner and my children
and I alone
may after this be called known or distinguished not by the old name but by the new name.
I AUTHORISE
and require all persons at all times to designate and address me by my adopted new name.
and entirely renounce relinquish and abandon the use of my old name and assume adopt and
determine to take and use from the date of this Deed my new name in substitution for my old name.
I SHALL
LOC020
05.15
on behalf of myself
continued over the page
I have subscribed my adopted and substituted
forename(s) surname(s)
of
(NEW NAME)
and also my said old
forename(s) surname(s)
of
(OLD NAME)
the day and first year above written.
WITNESS
Name
Signature
Address
Occupation
In the presence of
Signed as a Deed and delivered
(NEW NAME SIGNATURE)
By the above named
(NEW NAME)
Formerly known as
(OLD NAME) (OLD NAME SIGNATURE)
“Notwithstanding the
decision of Mr Justice
Vaisey in Re: Parrott, Cox
v Parrott, the applicant
desires the enrolment to
proceed”
IN WITNESS
LOC020 (05.15)
WITNESS
Name
Signature
Address
Occupation
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