Deed poll
Notice for the London Gazette on change of name for an adult
LOC025
02.12
NOTICE is hereby given that a Deed Poll dated
D D
/
M M
/
Y Y Y Y
and enrolled in the Senior Courts of England and Wales on (leave blank)
D D
/
M M
/
Y Y Y Y
Applicant’s new name
Applicant’s address
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
Abandoned the name of (APPLICANT’S OLD NAME)
and assumed the name of (APPLICANT’S NEW NAME)
Dated
D D
/
M M
/
Y Y Y Y
(If applicable, Solicitor’s details)
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