THIS CHANGE OF NAME DEED made this *day of * two thousand and * by I the undersigned [*new name] of [*address] now or formerly called [*old name].

WITNESSES AND IT IS HEREBY DECLARED as follows:

1. I absolutely and entirely renounce and relinquish and abandon the use of my former name of [*old name] and assume adopt and determine to take and use from the date hereof the names of [*new name] in substitution.
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 new name and in substitution for my former names so relinquished as aforesaid to the intent that I may hereafter be known or identified by my new names and not by my former names.
3. I authorise and require all persons at all times to designate describe and address me by my new name.

SIGNED AS A DEED AND }
DELIVERED by the said }
[*new name] }
in the presence of:

ДАННОЕ СВИДЕТЕЛЬСТВО О ПЕРЕМЕНЕ ИМЕНИ составлено сегодня 18 января две тысячи седьмого года Мной, нижеподписавшимся ............., проживающим по адресу ........., сейчас и ранее известного как ........., гражданин Великобритании
СВИДЕТЕЛЬСТВУЮ И ЗАЯВЛЯЮ от своего имени о следующем:
1. Я абсолютно и полностью отказываюсь от использования моей прежней фамилии .....