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					                                 DEED POLL
By this Change of Name Deed, I the undersigned,

of
who was born at
on the

DO HEREBY ABSOLUTELY RENOUNCE AND ABANDON the use of my former name

and in lieu thereof assume and adopt the name


In pursuance of such assumption I HEREBY DECLARE that I shall at all times hereafter
in all records deeds and instruments in writing and in all actions and proceedings and
upon all occasions whatsoever use the name

as my full names and my family name and I HEREBY AUTHORISE AND REQUEST all
persons to designate and address me by such names.

In witness whereof I have hereunder signed my given name of

and my family name of

Dated this ….......….day of……………..….…two thousand and ……………………….


Signed by the said :                                              .......................................new signature


                                                                  .......................................old signature


In the presence of:

Witness Name………………………………                                          .......…….........................witness signature

Witness Address......................................

          ....................................................

          ....................................................

          ....................................................

          .....................................................

Witness Occupation...................................
                                 DEED POLL
HOW TO COMPLETE YOUR DEED POLL

By this Change of Name Deed, I the undersigned,
your new full name
of your home Town, County & Country of residence
who was born at your Town, County & Country of birth
on the your date of birth

DO HEREBY ABSOLUTELY RENOUNCE AND ABANDON the use of my former name
your old full name
and in lieu thereof assume and adopt the name
your new full name

In pursuance of such assumption I HEREBY DECLARE that I shall at all times hereafter
in all records deeds and instruments in writing and in all actions and proceedings and
upon all occasions whatsoever use the name
your new full name
as my full names and my family name and I HEREBY AUTHORISE AND REQUEST all
persons to designate and address me by such names.

In witness whereof I have hereunder signed my given name of
your new first and middle names
and my family name of your new surname.

Dated this ….......….day of……………..….…two thousand and ……………………….


Signed by the said :                                              .......................................new signature


                                                                  .......................................old signature


In the presence of:

Witness Name………………………………                                          .......…….........................witness signature

Witness Address......................................

          ....................................................

          ....................................................

          ....................................................

          .....................................................

Witness Occupation...................................
NOTES TO HELP YOU COMPLETE YOUR DEED POLL
The example shown above features text in red italics. This red text shows you how to correctly
complete the blank Deed Poll document.

Signatures
Three signatures are required to complete the certificate. The person changing their name must
sign both their old and new signatures in the spaces marked. The person witnessing the name
change must also sign the form in the space provided. All three signatures must be completed in
Black ink.

Witness
The witness can be anyone over the age of 18 provided that they are not directly related to the
person changing their name. The witness’s name address and occupation must be written into
the spaces provided. The witness is signing that he/she has witnessed the person changing their
name sign both their old and new signature onto the deed poll certificate.

The document is now complete. It should be sent to the Passport Office, DVLA, and all
companies and organisations, which hold your personal details, (Banks, Electricity/Gas/Water
supplier, employer etc.); to provide evidence of your name change so that stored records can be
changed to reflect the name change.

				
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posted:8/13/2010
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