APPLICATION FOR CHANGE OF NAME
UNDER THE PROVISIONS OF THE BRITISH COLUMBIA NAME ACT
NOTE TO ALL APPLICANTS Carefully read application requirements to ensure you provide ALL requested information ELIGIBILITY AND APPLICATION REQUIREMENTS
1.) All applications must include completion of Part 1 (a & b) by the applicant. An applicant may be a person changing their own name; or, a parent making application to change their child’s name. In most instances, a legal Change of Name, under the Name Act, may not be required for a person to return to their maiden surname. If unsure, please call (250) 952-2681 to verify. APPLICANTS MUST - Be at least 19 years old OR - IF less than 19 years old AND a parent, MUST have custody of their child - Have resided in B.C. for at least three months prior to making application. OR - Be domiciled in B.C. for at least three months just prior to application. 2.) CHANGING YOUR CHILD’S NAME An applicant who is a parent of a minor child (or children) may apply to change their child’s names if they; a) Have custody of the child AND b) Have the consent of the other parent OR an acceptable reason to request waiver of the consent. (See Request for Waiver, Page 5.) c) Have the consent of the child if the child is at least 12 years of age or over. d) Have the consent of the spouse if the child’s name is changing to the spouse’s name. e) A parent must act as applicant and complete Part 1(a) and Part 1(b) providing information on themselves. 3.) CRIMINAL RECORD CHECK All persons named on the application, whose names are to be changed and who are 18 years and older, are required to have fingerprints taken by a law enforcement officer. Any fees for fingerprinting are paid directly to the law enforcement agency and are not part of the Change of Name application fee or Criminal Record Check fee. The fingerprints will be submitted for a criminal record check after the change of name is registered. The package that you will need to present to the law enforcement agency for fingerprinting can be obtained from any Vital Statistics Agency Office or ServiceBC Office. You may also request the package be mailed to you by contacting us at HLTH.CNFORMS@gov.bc.ca or calling our general inquiries telephone line at 250 952-2681.
NOTE: Present name and birth information must match the information recorded on primary identification document and if appropriate, also supported by a marriage certificate. Once the application has been submitted no further alterations to the information recorded can be made without completing a new sworn application. VSA 529 2008/09/18 Pg.1
4.) FEES Applications must be accompanied with the required fee in the form of a money order or certified cheque payable to the Minister of Finance, or payment by credit card. All fees subject to change. Personal Cheques will not be accepted. An additional fee of $25 is required for each person 18 years and older whose name is being changed. This fee will be forwarded to the RCMP for payment of the criminal record check. Include this fee in the total amount submitted to Vital Statistics as the Agency will submit this on your behalf.
NOTE: Applicants who are changing their own names and/or the name of any child who is 18 years of age may be required to pay an additional payment directly to their local police department for fingerprinting services. Please check with your local police detachment to determine the cost and their desired method of payment
5.) SUPPORTING DOCUMENTS Applicants must provide the following: - All original birth certificates for each person whose name is to be changed if born in Canada. In the case of children, the birth certificate MUST show details of the parents of the child. - Certified photocopies of immigration and citizenship documents for any person whose name is to be changed who was not born in Canada and is a landed immigrant or a naturalized citizen of Canada. In the case of children, if parentage is not indicated, a photocopy of a birth certificate showing parentage. - An original provincial marriage certificate if a person whose name is to be changed was married in Canada. - A photocopy of a marriage certificate if a person whose name is to be changed was married outside of Canada. - If you are using a surname from a previous marriage a certified photocopy of the marriage certificate or divorce court order from the marriage to the person whose surname you assumed. - Any previous Change of Name certificates that prove continuity and support the change of name. - Consent forms from a) The other parent when a parent is changing their child’s name or a request for waiver of consent. b) The spouse when a parent is changing their child’s name to that of their spouse. - Proof of residency / domicile if requested. - Documents to support waiver of parental consent (see p. 7). 6.) Original documentation will not be returned upon Change of Name completion.
NOTE: A legal change of name will normally result in your original Canadian birth or marriage registration being changed and all certificates issued subsequent to the change will reflect your new name. Please contact a Vital Statistics Agency office should you have any questions regarding the effect of a legal change of name.
Ensure that you have completed the application in full, including having your signature witnessed on the statutory declaration(s), and that the payment is included before proceeding to your local police department for fingerprinting.
Checklist of Items Required
BEFORE YOU SEND IN YOUR APPLICATION
WHAT IS A “CURRENT LEGAL NAME”? For the purposes of a legal change of name the following represents your current legal name:
Applicant – Part 1
❒ ❒ ❒
Fees (Credit Card, Certified Cheque or Money Order payable to the Minister of Finance) All Original Provincial Birth Certificates (if born in Canada and name is changing, otherwise send a certified photocopy) Certified copy of Immigration and Citizenship Documents (if born outside Canada and are a landed immigrant or naturalized citizen of Canada). For example, one of the following:
If you were born in Canada, the name that appears on the birth certificate of the person whose name is to be changed. If the name has been previously legally changed in Canada the name will be as on a birth certificate issued following the legal name change; OR If you were born outside of Canada, the name that appears on identity documentation issued to you by Canadian Immigration authorities, such as a residency card or citizenship certificate. If the name has been changed since receiving your immigration documents, your current legal name is as per the change of name certficiate.
NAME CHANGES FOR CHILDREN UNDER 18 YEARS OF AGE If you ARE NOT changing your own name, and you are only changing the names of a child under the age of 18 years, you may mail your application to the location indicated below. Record of Landing - IMM 1000 (papers stamped “not valid If you are changing more than one child’s name, please for travel” are not acceptable) photocopy page 5, Application for Change of Name Part 2, Child’s Particulars. Front and back of Citizenship Card Front and back of Residency Card NAME CHANGES FOR ADULTS AND/OR CHILDREN 18 YEARS OF AGE OR OLDER If you ARE changing your own name and/or the name of a child who is 18 years of age or older, your application must be submitted through your local police or RCMP detachment so that fingerprinting may be completed. Your local police detachment personnel will forward all material and fees submitted with your application, together with copies of your fingerprints in a sealed envelope to Vital Statistics. Fees for fingerprinting are payable directly to the local police detachment office, and are separate from the fee for submission to Vital Statistics. Please check with your local police detachment to determine the cost of fingerprinting and their desired method of payment. Once your name change has been processed, your change of name certificate will be issued and information regarding the change of name, along with your fingerprints will be sent to the RCMP in Ottawa for the purpose of a criminal record check. Once the check has been completed, the RCMP will return a fingerprint record (not the original fingerprints), to you. Your fingerprint record will not be retained on file with the local police detachment, the Vital Statistics Agency, or the RCMP as a result of your undertaking a legal name change in British Columbia. For the location of police services, please refer to the following websites: www.rcmp.ca/detachments/generalcont_e.htm or www.opcc.bc.ca/External Links/Municipal Agencies OPCC has authority over.htm If you would like to discuss the process, please contact the Vital Statistics Agency at the following location: MAILING ADDRESS & TELEPHONE NUMBER Vital Statistics Agency PO Box 9657 Stn Prov Govt Victoria BC V8W 9P3 GENERAL INQUIRIES: 250 952-2681 or visit our website at: www.vs.gov.bc.ca/name/index.html
❒ ❒ ❒ ❒
Original Provincial Marriage Certificate (if married and marriage occurred in Canada, otherwise send a photocopy) Any previous Change of Name Certificates All signatures present Signatures witnessed
Child – Part 2
❒ ❒ ❒ ❒ ❒ ❒ ❒
All original Provincial Birth Certificates showing parentage (if born in Canada, otherwise send a certified photocopy) Certified copy of Immigration Record (if born outside Canada or United States) Custody papers (photocopy) Child's signature - if 12 years or older Spouse's consent Other natural parent's consent, or request for waiver completed
(form included in this package to be signed in the presence of a Commissioner for taking Affidavits, Lawyer or Notary Public)
Statutory Declaration to support a Request for Waiver
NOTE:The minimum time for completion of a name change request is anticipated to be fifteen working days from receipt by Vital Statistics. If we are required to obtain additional information or documents this time frame will be longer. If you were born in Canada and require a new birth certificate reflecting your legal change of name, you must apply and pay the fees required for that document in the province of your birth after the change is completed. Be sure to advise them of your recent change of name and enclose a photocopy of your Name Change Certificate. Certificates issued in British Columbia are generated in upper case lettering only.
VSA 529 2008/09/18 Pg. 2
APPLICATION FOR CHANGE OF NAME PART 1 (a)
APPLICANT’S INFORMATION
INTENT OF CHANGE CURRENT LEGAL NAME PROPOSED NAME (if applicable) DATE & PLACE OF BIRTH
To be completed by the person applying to change their own name, or by a PARENT applying on behalf of their child ❒
GIVEN NAMES ONLY
❒
SURNAME ONLY
❒
BOTH SURNAME & GIVEN NAMES
❒
NO CHANGE (Changing Child’s Name Only)
AFS #
OFFICE USE ONLY
* NOTE: A change of name will normally be reflected on the Registration of Birth and Marriage if the event occurred in British Columbia (and within Canada in most cases)
SURNAME GIVEN NAME MIDDLE NAME(S) SEX
REG. #
SURNAME
GIVEN NAME
MIDDLE NAME(S)
DATE OF BIRTH MMM DD YYYY
PLACE OF BIRTH
(City / Town)
(Province / State / Country)
❒
MARITAL STATUS AND DETAILS
MARRIED
❒ WIDOWED
YYYY
❒ DIVORCED
❒ NEVER MARRIED
MARRIED SURNAME
DATE OF MARRIAGE MMM DD
PLACE OF MARRIAGE
(City / Town)
(Province / State / Country)
STREET
CITY
POSTAL CODE
PHONE NUMBER FROM MMM
PLACES OF RESIDENCE FOR LAST THREE MONTHS
* *
DD
YYYY
TO MMM
* *
DD
YYYY
* You must complete these date fields
ADDRESS FOR CORRESPONDENCE OR CERTIFICATE
(if different from above)
STREET
CITY
POSTAL CODE
FROM MMM
DD
YYYY
TO MMM
DD
YYYY
MAIL TO:
❒ ABOVE ADDRESS
❒ ALTERNATE ADDRESS BELOW:
NAME/ORGANIZATION STREET CITY PROV./STATE
_________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ ______________________________________________________________________________ POSTAL CODE __________________________
REASON FOR CHANGE
❒ ❒ ❒
ALIGN CHILD'S NAME RELIGIOUS ANGLICIZE
❒ RETAIN FAMILY NAME ❒ DIVORCE ❒ PROFESSIONAL
PAYMENT METHOD
❒ NUMEROLOGY ❒ PERSONAL: (describe)
________________________________________________________________
PAYMENT DETAILS
FEES Adult (greater than or equal to 19 years of age) without dependant child (18 years or younger) $137.00 Name Change Fee $ 25.00 Criminal Record Check Fee $162.00 TOTAL FEES Adult (greater than or equal to 19 years of age) with dependant child (18 years or younger) $137.00 Name Change Fee $ 27.00 For Each Child $ 25.00 Criminal Record Check Fee for Each Adult & Adult Child For Child Only $137.00 Name Change Fee for first or only child $ 27.00 For each additional child For Birth or Marriage Search $ 27.00 If event occurred in BC (if certificate not enclosed)
VSA 529 2008/09/18 Pg. 3
Certified Cheque (Post dated cheques or personal cheques not accepted) Money Order Credit Card Visa MasterCard American Express Credit Card number: Card Holder Name as shown on Credit Card: Expiry date: Card Holder Signature: TOTAL AMOUNT ENCLOSED OR AUTHORIZED FOR PAYMENT $
To be completed by the person applying to change their own name, or by a parent applying on behalf of their child DOCUMENTATION
ORIGINAL BIRTH CERTIFICATE (IF BORN IN CANADA) BIRTH REGISTRATION NO.
APPLICATION FOR CHANGE OF NAME PART 1 (b)
PROOF OF BIRTH
❒
ENCLOSED
❒ $27.00 SEARCH FEE (IF YOU WERE BORN IN BRITISH COLUMBIA
AND DO NOT HAVE A BIRTH CERTIFICATE)
CERTIFIED COPY OF IMMIGRATION AND CITIZENSHIP DOCUMENTS (IF BORN OUTSIDE CANADA)
❒
PROOF OF MARRIAGE
ENCLOSED
PROVINCIAL MARRIAGE CERTIFICATE (if married)
MARRIAGE REGISTRATION NO.
❒
ENCLOSED
❒ $27.00 SEARCH FEE (IF YOU WERE MARRIED IN BRITISH COLUMBIA
AND DO NOT HAVE A MARRIAGE CERTIFICATE)
STATUTORY DECLARATION
I understand that by making application for a name change for myself or my minor child age 18 or under, the present and proposed names, date of birth and any other personal information included in this application deemed necessary, together with the fingerprint envelope sent with the application, will be forwarded to the Royal Canadian Mounted Police for the purpose of conducting a criminal record check. AND I have read the application and to the best of my knowledge, information and belief, the statements made are true in substance and in fact
APPLICANT’S STATUTORY DECLARATION
AND I have enclosed all Birth Certificates in my/our possession for each person whose name is to be changed if born in Canada, all Marriage Certificates if applicable, and any previous change of name certificates, and I understand they will not be returned on completion of a name change. AND I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath. X __________________________________________________________________________________________________________________
SIGNATURE OF APPLICANT _______________ ,___________________________________________________________, ______________________ Day Month Year
Declared before me at_____________________________________________________________________________________ City in the Province of British Columbia, this
_______________ Day
day of
___________________________________________________, ______________________ Month Year
X __________________________________________________________________________________________________________________
SIGNATURE OF LAWYER, NOTARY PUBLIC OR COMMISSIONER FOR TAKING AFFIDAVITS
Fingerprints are required for all persons in the application who are 18 years of age and over, and whose names are to be changed.
SURNAME OFFICIAL WHO OBTAINED FINGERPRINTS OFFICE LOCATION DATE
MMM DD YYYY
GIVEN NAME BUSINESS TELEPHONE NUMBER SIGNATURE RCMP Municipal Police VS Official Use Only
The information on this form is collected under the authority of the Name Act (RSBC 1996, c.328, Sec. 7 (2)) and will be used to fulfill the requirements of the Name Act. Any release of this information will be in compliance with the Name Act and the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please contact a Vital Statistics representative at 250 952-2681
VSA 529 2008/09/18 Pg. 4
APPLICATION FOR CHANGE OF NAME
(IF CHANGING A CHILD’S NAME COMPLETE AS REQUIRED)
PART 2 CHILD’S PARTICULARS
❒
BOTH SURNAME & GIVEN NAMES GIVEN NAME
INTENT OF CHANGE CURRENT LEGAL NAME OF CHILD PROPOSED NAME OF CHILD DATE & PLACE OF BIRTH PROOF OF BIRTH SHOWING PARENTAGE CHILD’S CONSENT
IF CHILD IS AGE 12 - 18 YEARS
❒
SURNAME ONLY
❒
GIVEN NAMES ONLY
SURNAME
MIDDLE NAME(S)
SURNAME
GIVEN NAME
MIDDLE NAME(S)
DATE OF BIRTH MMM DD
YYYY
SEX
PLACE OF BIRTH
(City / Town)
(Province / State / Country)
BIRTH CERTIFICATE (IF BORN IN CANADA) $27.00 SEARCH FEE (IF YOU WERE BORN IN BRITISH COLUMBIA ❒ ORIGINAL ENCLOSED ❒ AND DO NOT HAVE A BIRTH CERTIFICATE) IMMIGRATION AND CITIZENSHIP DOCUMENTS (IF BORN OUTSIDE CANADA)
BIRTH REGISTRATION NO.
❒
CERTIFIED COPY ENCLOSED
I HERBY GIVE MY CONSENT TO CHANGE MY NAME AS STATED IN THIS APPLICATION CHILD’S SIGNATURE
X_____________________________________________________________
MMM DATE DD YYYY
SIGNATURE OF WITNESS
X
______________________________________________________ MMM DATE DD YYYY
I, _______________________________________________________________ AM THE NATURAL _______________________________________________________________
NAME (printed) MOTHER / FATHER
CONSENT OF OTHER PARENT
OF _____________________________________________________________________________________________________________________________________________
CHILD’S FULL NAME
AND HEREBY GIVE MY CONSENT TO CHANGE MY CHILD’S NAME TO ____________________________________________________________________________________ MMM SIGNATURE DD YYYY
X X
_________________________________ ADDRESS ____________________________________________________
DATE MMM DD YYYY
WITNESS
_________________________________ ADDRESS ____________________________________________________
DATE
I REQUEST THAT THE CONSENT OF
________________________________________________________________________________________________________________
SURNAME GIVEN NAME (S)
WHO IS THE _______________________________________ OF MY CHILD BE WAIVED FOR THE FOLLOWING REASON:
MOTHER / FATHER
The person whose consent is required is not recorded on the registration of live birth of the person whose name is to be changed. (s.4.6 of the Name Act) The person whose consent is required cannot be located after a reasonable, diligent and adequate search has been conducted as demonstrated by statutory declaration and supporting evidence maintained in the change of name file. (s.4.5(a) of the Name Act)
REQUEST FOR WAIVER
The person whose consent is required is deceased, proven by a copy of a death certificate maintained in the change of name file. (s.4.6 of the Name Act) A person whose consent is required is unreasonably withholding their consent (s.4(5)(b) of the Name Act) The person whose consent is required is mentally disordered, as demonstrated by statutory declaration and supporting evidence. (s.4.5(a) of the Name Act) Exceptional circumstances make it unreasonable to seek the consent of the required individual (s.4(6) of the Name Act)
PLEASE SEE THE INFORMATION SHEET ON PAGE 7 FOR MORE INFORMATION ON SUPPORTING DOCUMENTATION A DETAILED EXPLANATION OF CIRCUMSTANCES MUST BE PROVIDED IN THE FORM OF A STATUTORY DECLARATION - INCLUDED IN THIS PACKAGE
MMM SIGNATURE DD YYYY
X X X
DATE
CONSENT OF SPOUSE OF APPLICANT
USE ONLY IF CHILD’S SURNAME IS CHANGING TO THAT OF APPLICANT’S SPOUSE
I,_____________________________________________________________________
NAME (printed)
________________________________________________________________
SIGNATURE OF SPOUSE OF APPLICANT
HEREBY CONSENT TO THE NAME CHANGE FOR ______________________________________________________________________
CHILD’S FULL NAME
________________________________________________________________
SIGNATURE OF WITNESS
CHANGING TO ______________________________________________________________________
MMM DATE
DD
YYYY
VSA 529 2008/09/18 Pg. 5
USE A SEPARATE FORM FOR EACH CHILD (PHOTOCOPY WHEN NECESSARY)
STATUTORY DECLARATION
This Statutory Declaration MUST be completed and processed if the Applicant is asking for Waiver of Consent of the Other Parent. See page 5, Request for Waiver section for details. Please list when last contact was made with the other parent and what attempts have since been made to gain the parent’s consent to this name change.
CANADA:
Province of British columBia. to Wit:
I,
of
}
In the Matter of
in the Province of British Columbia, do solemnly declare that
I verify that all supporting documents represent current circumstances and orders in affect as of this date. And I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath and by virtue of the “Canada Evidence Act.” Declared before me at in the Province of British Columbia, this day of ,
YYYY
}
Declarant’s signature
Signature of Lawyer, Notary Public or Commissioner for Taking Affidavits
The information provided on this declaration and application is subject to release under the Name Act and in conjunction with the Freedom of Information and Protection of Privacy Act.
VSA 529 2008/09/18 Pg. 6
APPLICATION FOR CHANGE OF NAME
UNDER THE PROVISIONS OF THE NAME ACT, BRITISH COLUMBIA
INFORMATION - REQUEST FOR WAIVER FOR FATHER/MOTHER CONSENT
Section 4 (5) (a) of the Name Act allows a parent to request the CEO to legally change the name of a minor child without the consent of the other parent if the other parent is deceased, mentally disordered or cannot be located after a reasonable, diligent and adequate search to locate the other parent of a child for consent has been conducted and is unsuccessful. Proof of a reasonable, diligent and adequate search should include: a) b) c) searching the telephone book; searching applicable Internet sources (ie. Canada 411); contacting the family of the other parent in an attempt to reach them directly. If you are unable to contact the family please note this fact in your statutory declaration and state the reasons why you were unable to talk to the family.
This search must be current and should take place within two weeks of making your application. After conducting the search you must document your search in a statutory declaration, see page 6. The statutory declaration must contain the following information: 1. A full statement concerning the current whereabouts of the other parent. If you are aware of their location please identify the reasons why you have been unable to contact them. If you do not know the current whereabouts of the other parent please state this fact in the declaration and document your search findings (from the resources above) and include Canada 411 screen printouts. An example of a paragraph in your declaration may be: “I do not know the current whereabouts of (insert name). I have conducted a reasonable and adequate search in an attempt to locate this person and my search was unsuccessful. I conducted a diligent search of the telephone book, Canada 411 (Printouts attached) and contacted his/her family without success.” 2. A statement regarding your last contact with the other parent and their last known address. In your statement include the month/day/year of your last contact with the person. Any additional statements you believe will help us make an informed decision on your request. The Chief Executive Officer may also waive the consent under sections 4(5)(b) and 4(6) of the Name Act where either a person whose consent is required is unreasonably withholding their consent, or exceptional circumstances make it unreasonable to seek the consent of the required individual. A request for consent of waiver under these sections of the Name Act must be substantiated through applicable documentation such as court orders or police services endorsement.
3. 4.
NOTE: We require all of the above information listed here. The requirements identified in this information sheet are a guide only and the Chief Executive Officer of the Vital Statistics Agency has the authority to ask for additional information. Also note that information contained in your application may be released to any person who has been named on the application form.
VSA 529 2008/09/18 Pg. 7
APPLICATION FOR CHANGE OF NAME
UNDER THE PROVISIONS OF THE NAME ACT, BRITISH COLUMBIA
FINGERPRINTING INFORMATION FOR APPLICANT
If you are changing your own name, or the name of a child age 18 or under, please read the information below. In the spring session of the 2002 legislature the Government of British Columbia passed an amendment to the Name Act. (R.S.B.C. 1996 c. 328), requiring individuals whose name was to be changed to have their fingerprints taken for the purpose of having a criminal record check conducted. This was done to ensure criminal records would be updated in those instances where a person having a criminal record has applied for a change of name. The requirement to have fingerprints taken applies where any person whose name is to be changed is aged 18 or over. This includes applicants age 19 and over and any minor children age 18 included in an application. The package that you will need to present to the law enforcement agency for fingerprinting can be obtained from any Vital Statistics Agency Office or ServiceBC Office. Or, you can request the package be mailed to you by contacting us at HLTH.CNFORMS@gov.bc.ca or calling our general inquiries telephone line at 250 952-2681. In order to meet the requirements of the Act the applicant must;
Complete the application form, the relevant portions of the C-216-C, and fingerprint envelope as per the instructions provided; Gather all documents related to the persons whose names are being changed as required by the Act (also as per the instructions provided in the change of name kit); Make the Statutory Declaration included in the application, witnessed by a lawyer, notary public or Commissioner for Taking Affidavits; Provide primary identification when making the Statutory Declaration; Provide for the payment of fees to the Minister of Finance of British Columbia as specified in the application instructions, and; Within 30 days of taking the statutory declaration, accompanied by any other person age 18 or older whose name is to be changed as part of the application, take to their local police department (municipal police station or RCMP detachment) all documents specified above.
If the police department requires a payment of a fee for taking fingerprints the applicant will be responsible for paying these fees directly to the police department separate from any fees required by the change of name process. Once fingerprints have been taken, applicants are not permitted access to any documents associated with the change of name application until processing is completed by the VSA and the Criminal Identification Unit of the RCMP. Fingerprints will only be used for the purpose required by the Act and confirmation of criminal record check forms will be returned to the applicant directly from the Criminal Identification Unit of the RCMP.
The Instruction below must be presented to your local police or RCMP detachment once you have completed, signed, and obtained the signature of a valid witness on the Change of Name Application.
INSTRUCTIONS FOR POLICE OFFICIALS
The police officer or police employee must do the following to ensure the integrity of the name change process: 1. Confirm identity of the applicant and the persons listed in the application who are 18 years of age or older by reviewing primary identification (any documents such as birth certificates or certified copies of immigration and citizenship documents required as part of the application) and secondary identification (photo identification i.e. drivers licence etc.) Fingerprint the applicant and persons listed in the application who are 18 years of age or older using C-216C fingerprint form provided in the application kit. Complete the C-216C fingerprint form in its entirety ensuring “LEGAL NAME CHANGE” is noted in the “Reason for Application” box and the new name both given and surname are recorded in the “RCMP Identification Use” box on the form. (Note: if the provided C-216C form is damaged or destroyed in the fingerprinting process use existing blank C-216C police office forms, however rerecord all the pre-printed information found on the C-216C which has been provided in the application kit). Seal the fingerprints in the white envelope provided for this purpose ensuring the new name, old name, address and birth date have been correctly recorded on this envelope by the applicant. Stamp the outside of this envelope with your police departments stamp. Record the name of the police personnel that obtained the fingerprints on the APPLICATION FOR CHANGE OF NAME form Part 1 (b), along with their signature and date signed. Hand write in the remaining information or stamp the application form with the police department or police detachment address stamp. Place the application, fingerprint envelope and other accompanying documents, which will include primary identification, and payment for name change and criminal record check in the business reply envelope. Stamp your departments/detachments address on this envelope as the return address and mail this document to VSA. The applicant is required to submit a cheque payable to the Minister of Finance for $137.00 application fee, $27.00 for each additional child on the application, $25.00 per person fingerprinted age 18 or older which is the Ottawa Criminal Record Check fee. The applicant will also have to submit a separate payment to the RCMP Detachment or Municipal Police Force in accordance with the department/detachment policies with regard to administration fees for the taking of fingerprints.
2.
3. 4.
5.
Once the fingerprints have been taken, under no circumstances is the application, fingerprints or accompanying documents to be returned to the applicant. The police must mail the documents directly to VSA in the business reply envelope provided in the application kit.
VSA 529 2008/09/18 Pg. 8