Deed poll
CHANGE OF NAME DEED intended for enrolling in the
Central Office of the Senior Courts of England and Wales
LOC020
05.15
Date the deed is made
D D
/
M M
/
Y Y Y Y
Your new name in full
Your address
Your old name
Status
Single
Married/Civil Partnership
Widowed Divorced/Civil Partnership dissolved
British Citizen British Dependent Territories Citizen
Commonwealth Citizen
Under section of the British Nationality Act 1981
WITNESSES AND IT IS
HEREBY DECLARED
on behalf of myself
I ABSOLUTELY
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
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.
continued over the page
IN WITNESS
“Notwithstanding the
decision of Mr Justice
Vaisey in Re: Parrott, Cox
v Parrott, the applicant
desires the enrolment to
proceed”
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.
Signed as a Deed and delivered
(NEW NAME SIGNATURE)
By the above named
(NEW NAME)
Formerly known as
(OLD NAME) (OLD NAME SIGNATURE)
WITNESS
Name
In the presence of
Signature
Address
Occupation
WITNESS
Name
Signature
Address
Occupation
LOC020 (05.15)
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