STATUTORY DECLARATION

 

 

I, [NEW NAME], formerly [OLD NAME] do solemnly and sincerely declare that:

 

1. I assume, adopt and determine to take and use from the date hereof the new name of [NEW 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 my new name of [NEW NAME] and that I may hereafter be called, known and identified by the new name of [NEW NAME] and not by my former name, [OLD NAME]

 

3. I authorise and require all persons, at all times, to identify, describe and address me by my new name of [NEW NAME].

 

I make this solemn declaration conscientiously, believing the same to be true and by virtue of the provisions of the Statutory Declarations Act 1835.

 

 

 

Declared at:  _____________________________

                    

                     ______________________________

 

                     ______________________________

 

 

 

This _____ day of _______ in the year __________

 

 

 

Witnessed by ___________________________________________

 

 

 

_____________________  Declarant formerly known as ______________________