Dated The Day of 20
______
Former Name of National
to
Current Name to be Used
______
Deed Poll:Evidencing Change of Name from
Former Name of National
to Current Name to be Used
Prepared by
By this Deed, I the undersigned Current Name of National of Village/Town Name in the parish of Parish Name, state of GRENADA, presently residing at Current Street Address, City, State and Zip Code,formerly Former Name of National a citizen of Grenada by birth, do hereby: ______.
For and on the behalf of myself and assume as from the date hereof, the christian names and surname Current Name of Nationalin place of the christian names and surname Former Name of National.
For the purpose of evidencing such my determination declare, that I shall at all times hereafter in all records, deeds and writings, and in all proceedings dealing and transactions, private as well as public, and upon all occasions whatsoever use and sign the said christian names and surnames, “Current Name of National” in place of the christian names and surname, “Former Name of National”.
Expressly authorities and request: all persons at all times hereafter to designate and address me by such christian names “Current Name of National” accordingly.
In witness whereof I have hereunto subscribed my christian names First and Middle Name(s) of National and my surname of Current Surname and also my former christian names and surnames of Former Name of National and affixed my seal this day of in the year .
Signed sealed and delivered)
by the above named)
Current Name of Nationalformerly)…………………………………………
Former Name of National)
in the presence of:…………………………………………
Lawyer/Notary Public
Iof in the city of , state of ,make oath and say as follows:
I was present and did see Current Name of National formerly Former Name of National duly sign seal and deliver as his act and deed the within writing Deed Poll dated this day of in the year , now produced and shown to me.
The signature, “Current Name of National formerly Former Name of National” set and subscribed to the said Deed Poll as that of the party executing the same is in the handwriting of the said Current Name of National.
The signature set and subscribed to the clause of attestation endorsed on the said Deed Poll as that of the witness to the Certificate is one and the same person.
I am not a relative of the saidCurrent Name of National.
I make this declaration from my own personal acquaintance with the said Current Name of National as aforesaid and my own knowledge of his intention to change his given name and of his carrying such intention into effect as evidenced by the said Deed Poll.
And I make this statutory declaration conscientiously knowing and believing the same to be true and by virtue of the oaths act.
Declared to at my office in the county of ,in the state
of,thisday of in the year .
Before me ……………………………………
Lawyer/Notary Public