Use this only where a name change has already taken place. Once completed it must be sworn before somebody empowered to take oaths.

Throughout, it is necessary to use the full names, including particularly all first names.

Statutory declaration as to change of name at common law by usage.

I, (new name) of (address) do solemnly and sincerely declare as follows:

1. I was born on (date) and in my birth certificate now produced and shown to me and marked ‘(initial-1)’ my name is stated to be (full forenames and original surname).
2. I was known by those names until (date).
3. On or about (date) I purchased the business of (description) carried on at (address) under the name and style of (new name).

   (or otherwise as appropriate to explain very briefly how the change of name came about)

4. Ever since (date) I have always and on all occasions used the forenames and surname (new names) being the names in which that business had been previously carried on and from that date relinquished and abandoned the use of my former names of (old names) and in place of them assumed the names (names). I have ever since (date) used those names in all records and documents and in all proceedings, dealings and transactions private as well as public in substitution for my former names of (old names).
5. I intend in all matters from today to continue to use the names (new names) and authorise and request all persons at all times from today to designate and address me by the names of (new names) [and my wife and children by the surname of (new name).]

   I make this solemn declaration conscientiously believing it to be true and by virtue of the provisions of the Statutory Declarations Act 1835.

   DECLARED at (place name) before me

   (signature of declarant)

   (signature of commissioner etc)