ACTUS FORMALIS DEFECTIONIS AB ECCLESIA

CATHOLICA
(Cfr. Can. 1086 1, 1117 & 1124)

To the Parish priest of the parish

of: .................................................................................................
Address ..................................... ....................................
date............................

SUBJECT: Request for formal defection from the Catholic Church

I, the undersigned ........................................................................................ born on the

date ......................... and baptised in the parish of ..................................................... formally
declare that I make an unequivocal personal, conscious and free decision to leave the Roman
Catholic Apostolic Church.

My baptism, made against my will, should be considered null and void.

I ask that this decision be noted in writing in the baptismal registry as a defectio ab Ecclesia
catholica actu formali as per cfr.can.535, 2.

Please find enclosed photocopy of photo identification document.

Yours truly,


Signature

Date