Change Your Name

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  • Topic: Family name, Given name, Personal name
  • Pages : 9 (1554 words )
  • Download(s) : 97
  • Published : April 4, 2013
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Statutory Declaration

to register change of name for an adult born overseas (18 years or over)

Births, Deaths and Marriages Registration Act 1995

Details to be completed by the person whose name is being changed The Registrar may not register a change of name unless satisfied: • of the identity and age of the person whose name is to be changed the change of name is not sought for a fraudulent or other improper purpose

False representation
If you knowingly provide false information in this statutory declaration, you may be guilty of an offence under Section 57 of the Births, Deaths and Marriages Registration Act 1995. Section 57 – False representation: A person who makes a representation in an application, notice or document under this Act or in response to a notice under Section 44 of this Act (Registrar’s powers of inquiry), knowing the representation to be false or misleading in a material particular, is guilty of an offence. Maximum penalty: 100 penalty units or 2 years imprisonment, or both. I, (full name presently being used)

of
(present residential address – a PO Box is not acceptable)

Suburb Phone number
(daytime phone number)

State

Postcode

(other phone number)

solemnly and sincerely declare that: • I have read and understand all the instructions in this document including ‘Your Right To Privacy’ and ‘Disclosure of Information’ I understand that it is a punishable offence to give false information in this application I understand that the NSW Registry of Births Deaths & Marriages may confirm or verify the validity of any document provided with this application to establish identity and eligibility for this change of name for an adult to be registered The new name stated below will be used by me for all purposes in the future and is not sought for fraudulent or improper purposes, and my former name(s) will not be used I solemnly believe this declaration to be true and correct and by virtue of the provisions of the Oaths Act 1900.



Statutory Declaration to register change of name for an adult born overseas (18 years or over)

Page 1 of 6

New name you want to register – to use for all purposes Family Name Given Name/s Name at birth – original name recorded on your birth certificate Family Name Given Name/s Sex Born at (full place of birth – you must provide evidence of your place of birth.) Male Female

Born on

/

/

(dd/mm/yyyy)

Father’s Full Name
(as recorded on birth certificate)

Mother’s Full Name
(as recorded on birth certificate)

Name you are using at present Family Name Given Name/s

Previous names
Please list all previous names you have used. Provide evidence of how you have changed your name. Failure to list all previous names may result in your application being refused. Please attach a separate page if there are more than five (5) previous names. Family Name Given Name/s Date Changed Where Changed

You must establish proof of your current name and all other names ever used. All previous change of name certificates in your possession must be returned to the Registry when lodging an application as they are no longer valid.

Statutory Declaration to register change of name for an adult born overseas (18 years or over)

Page 2 of 6

Full reason(s) why you are changing your name
Be specific, for example, one or two word reasons such as “personal” are not acceptable.

Criminal records
Do you consent to the Registrar obtaining your criminal record from the NSW Police Force in determining your application? You are not required by law to consent, but your application may be refused if the Registrar is not satisfied that the change of name is not sought for a fraudulent or improper purpose. YES NO Have you ever been convicted of a criminal offence is punishable by a prison sentence of 12 months or more? A conviction includes the making of an order under Section 10 of the Crimes (Sentencing Procedure) Act 1999. A conviction...
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