Deed Poll - Peter O’Connor & Son Solicitors LLP

Deed poll questionnaire

Current Name

First Middle Last

Have you used any other name other than the above in the last two years?(Required)

Yes

Please enter the other name(s) used

Are you an Irish or EU National?

If you are not an Irish to EU National, consent from the Minister for Justice & Equality must be obtained before you can apply to change your name.

Yes

Address

Street Address Address Line 2 City County ZIP / Postal Code Country

Date of Birth:

Phone

Mobile:

Email Address:

PPS / Tax Number

New Name

First Middle Last

Original Birth Certificate

If you can supply this document, please tick this box

Valid/Current Passport

If you can supply this document, please tick this box

Please detail any other relevant information not included above

Signed

Date

Add attachment

Max. file size: 256 MB.