DEED POLL ON CHANGE OF NAME – Adult

THIS CHANGE OF NAME DEED made this <<INSERT DAY e.g.25th >> day of <<INSERT
MONTH & YEAR e.g. July 2011>>

BY me the undersigned <<INSERT NEW NAME IN FULL>> of <<INSERT ADDRESS

EXCLUDING COUNTY AND POSTCODE>> in the County of <<INSERT COUNTY>> now
or lately known as <<INSERT OLD NAME IN FULL>> << INSERT EITHER: a British citizen
under section 1(1) OR a Commonwealth citizen under section 37(1)>> of the British
Nationality Act 1981

WITNESSES AND IT IS HEREBY DECLARED as follows:-

1. I ABSOLUTELY and entirely renounce relinquish and abandon the use of my said former
name of <<INSERT OLD NAME IN FULL>> and assume adopt and determine to take and
use from the date hereof the name of <<INSERT NEW NAME IN FULL>> in substitution for
my former name of <<INSERT OLD NAME IN FULL>>.

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 <<INSERT NEW NAME IN FULL>> as my
name in substitution for my former name of <<INSERT OLD NAME IN FULL>> so
relinquished as aforesaid to the intent that I may hereafter be called known or distinguished
not by the former name of <<INSERT OLD NAME IN FULL>> but by <<INSERT NEW
NAME IN FULL>> only.

3. I AUTHORISE and require all persons at all times to designate describe and address me
by the adopted name of <<INSERT NEW NAME IN FULL>>.

[N.B. IF YOU ARE CHANGING FORENAME(S) ADD THE FOLLOWING PARAGRAPH:

Notwithstanding the decision of Mr Justice Vaisey in Re: Parrott, Cox v Parrott, the applicant
desires the enrolment to proceed]

IN WITNESS whereof I have hereunto subscribed my adopted and substituted name of

<<INSERT NEW NAME IN FULL>> and also my said former name of <<INSERT OLD
NAME IN FULL>> and have set my hand the day and year first above written.

SIGNED AS A DEED By the above named

<<INSERT NEW NAME>>

<<INSERT NEW SIGNATURE>>

Formerly known as

<<INSERT OLD NAME>>

<<INSERT OLD SIGNATURE>>

1
In the presence of

<<INSERT FIRST WITNESS SIGNATURE>>

<<INSERT FIRST WITNESS FULL NAME>>

<<INSERT FIRST ADDRESS>>

<<INSERT SECOND WITNESS SIGNATURE>>

<<INSERT SECOND WITNESS FULL NAME>>

<<INSERT SECOND WITNESS ADDRESS>>

This deed poll on change of name is based on a free document supplied by The Legal Stop
Limited through its website www.thelegalstop.co.uk

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