Gendered Intelligence: Understanding diversity in creative ways

Free Deed Poll Template

Below is a template you can use yourself to change your name. Print off and fill in your FULL old name whenever 'OLD NAME' is written, and your FULL new name wherever 'new name' is written, unless otherwise stated:


By this deed of change of name made by myself the undersigned NEW NAME of YOUR ADDRESS formerly known as OLD NAME.

Hereby declare as follows:

  1. I absolutely and entirely renounce, relinquish and abandon the use of my former name of OLD NAME and assume, adopt and determine to take and use from the date hereof the name of NEW NAME in substitution for my former name of OLD NAME.

  2. I shall at all times hereafter in all records, deeds, documents and other writings and in all actions and proceedings, as well as in all dealings and transactions and on all occasions whatsoever use and subscribe the said name of NEW NAME as my name, in substitution for my former name of OLD NAME so relinquished as aforesaid to the intent that I may hereafter be called, known or distinguished by the name of NEW NAME only and not by my former name of OLD NAME.

  3. I authorise and require all persons at all times to designate, describe and address me by the adopted name of NEW NAME.

In witness whereof I have hereunto subscribed my adopted and substituted forenames of NEW FORENAMES and my surname of NEW SURNAME and also my said former name of OLD NAME.

Dated this_____day of____________in the year______.

Signed as a deed
by the above named

NEW NAME __________________

Formerly known as OLD NAME ____________________

In the presence of ________________________

Address _______________________________

Occupation _____________________________

Witness signature __________________________

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