Form G - Deed Poll/sworn Affidavit printable pdf download

Form- G

DEED POLL/SWORN AFFIDAVIT

READ INSTRUCTIONS CAREFULLY. INCOMPLETE APPLICATIONS WILL NOT BE ACEPTED

By this deed I, the undersigned ___________________________________________________(new name)

( Surname)

(Given Names)

now lately called_______________________________________________________________ (old name),

(Surname)

(Given Names)

doing ______________________________(given profession or avocation) and resident of

__________________ City ____________________ State __________________ Post Code ___________

do hereby solemnly declare:

1. That for and on behalf of myself and my wife and children and remitter issue I wholly renounce/

relinquish and abandon the use of my former name/surname of __________________________________

and in place thereof I do hereby assume from this date the name/surname ___________________________

__________________and so that I and my wife and my children and remitter issue may hereafter be called,

known and distinguished not by my former name/surname, but my assumed name/surname.

2. That for the purpose of evidencing such my determination declare that I shall at all times hereafter in all

records, deed and writings and in all proceedings dealings and transactions, private as well and upon all

occasions whatever use and sign the name of ______________________________________________

_______________as my name/surname in place and substitution for my former name/surname.

3. That I expressly authorise and request all persons in general, relatives and friends in particular at all

times hereafter to designate me, my wife, my children, remitter issue by such assumed name/surname of

_______________________________________________________________________ accordingly.

4. In witness whereof I have hereunto subscribed my former and adopted name/surname of

_____________________________________and ________________________________________office

my signature and seal, if any, the_____________________________ day of _______________________.

Signed, sealed, and delivered by the above name ______________________________________________

Formerly _______________________________________________________________ in the presence of

1. Name ______________________________________________________________________________

(Surname)

(Given Names)

Address _______________________________________________________________________________

City ___________________ State _________________________ Post Code ___________________

2. Name _______________________________________________________________________________

(Surname) (Given Names)

Address ______________________________________________________________________________

City ___________________ State __________________________Post Code ___________________

Form G - Deed Poll/sworn Affidavit