REGISTRATION OF DOCUMENTS ORDINANCE

(CAP 117)

DEED POLL

THIS CHANGE OF NAME DEED is made this (insert date) day of (insert month) (insert year) by me
(desired/new name) formerly known as (former name) or sometimes as (other name if any) of Post Office
Box Number …………………., a resident of (street, district, city) now or until recently called (former
name).

WITNESSES AND IT IS HEREBY DECLARED as follows:

1. I absolutely renounce and abandon the use of my said former names of (insert former name)
and (insert other name if any) and I assume and determine to take and use the new name of
(insert new name) in substitution of my former names of (insert former name) and (insert other
name if any).

2. AND IN PURSUANCE of such change of name(s) as aforesaid I DECLARE I shall at

all times hereafter in all records, documents and other writings and in all actions and
dealings and on all occasions whatsoever use the new name of (insert new name) in
substitution for my former names of (insert former name) and (insert other name if any) so
relinquished as aforesaid to the intent that I may hereafter be known not by the aforesaid
former names, but by the new name of (insert new name) only.

3. AND I HEREBY AUTHORISE AND REQUIRE all persons at all times to describe and
address me by the new name of (insert new name).

IN WITNESS whereof I have hereunto subscribed my new name of (insert new name) and have
affixed my signature the day and year herein written.

SIGNED and DELIVERED by the said

………………………. introduced to me ………………..
by ………………………, the latter Deponent
known to me personally in my presence
this … day of ……………….. 20………

BEFORE ME:
NAME: _____________________________
SIGNATURE: _______________________
POASTAL ADDRESS: _______________
OCCUPPATION: ____________________

Consult: poli.consultantz@gmail.com