Gendered Intelligence: Understanding diversity in creative ways

Sample Statutory Declaration for change of name

The format varies, depending on whether you are changing your first names, your surname or both. This sample is for someone who is only changing their first names.

I NEW NAME of 123 High Street, Somewheretown, Somewhereshire AB12 3CD


I absolutely and entirely renounce relinquish and abandon the use of my former christian name of OLD NAME and assume adopt and determine to take and use the christian names of NEW NAME in substitution for my former christian name of OLD NAME.

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

I authorise and require all persons at all times to designate describe and address me by the adopted names of NEW NAME and I make this solemn Declaration conscientiously believing the same to be true and by virtue of the provisions of the Statutory Declarations Act 1835.

SIGNED AND DECLARED at in the County of this ________ day, the __________ of _______________ 20__)

Before me _________________) Solicitor/Commissioner for Oaths

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