Adult Deed Poll Application Form

Change of name deeds are available from Dudley register office - £50 each

please complete an application form when applying for a deed

Applicant’s details
Name of the person applying for the deed
Address
Email address
Telephone number (daytime)
Deed Poll details
Old Forename(s)
Old Surname
New Forename(s)
New Surname
Date of birth / ……/……/………… IMPORTANT - you must be 18 or over and bring your birth certificate to your appointment
Status / *Single / Married / Civil Partner / Widowed / Surviving civil partner / Divorced / Civil partnership dissolved * please delete as appropriate
Are you a British Citizen? / Yes / no
Have you ever been known by any name other than the one on your birth certificate? / Yes / no
If yes you will need to bring evidence to your appointment (eg. marriage certificate, deed poll)
Fees: The change of name deed costs £50. Extra copies are £10 each. We will store a copy of your deed poll at the register office so that copies can be purchased at any time in the future should you require them.
Quantity required / Fee enclosed / £
Signature of applicant / Date

Please return this form and payment to Dudley Register Office, Priory Hall, Priory Park, Dudley DY1 4EU. We will prepare your deed as soon as we receive the payment and will contact you to arrange an appointment for you to check and sign your deed poll. Please note the fee paid is non-refundable.

Email: Tel: 01384 815373

How to make payment ;

Debit/credit card ;

When you have completed this form, please upload it and make your debit/credit card payment by using the same link on our Website, used when you downloaded it.

If you are required to submit additional documents or photographs to support your request, you will be advised how to do this on the upload page.

Cheques;

Please return this form and a cheque made payable to DudleyMBC, to Dudley Register Office, Priory Hall, Priory Park, Dudley DY1 4EU