Application to change an adult name - Ontario Canada

Dec 17, 2018 | Publisher: Global Documents | Category: Civic & Government |  | Collection: Legal Forms

11155E (2018/04) Queen's Printer for Ontario, 2018 Disponible en franais Ministry of Government and Consumer Services Office of the Registrar General Application to change an adult's name To use this application: you must be 16 years of age or older, and you must have lived in Ontario for at least the past 12 months Personal information on this form is collected under the authority of the Change of Name Act, R.S.O. 1990,c.C.7. It will be used to determine whether a change of name can be granted, to register and record the change of name, to publish the change of name in The Ontario Gazette, to provide certified copies of the registration, certificates and search notices and for statistical, research, medical, security and law enforcement, corrections, adoption and adoption disclosure purposes. It is an offence to willfully make a false statement on this form. For any questions about this collection statement or any questions about this application, please contact: The Deputy Registrar General Office of the Registrar General PO Box 3000, 189 Red River Road Thunder Bay ON P7B 5W0 Telephone: Outside Toronto but within North America 1-800-461-2156 or in Toronto or outside North America 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408 Fax: 807-343-7459. 11155E (2018/04) - Application to Change an Adult's Name - Introduction Important Information about this Application 1. This application is a permanent legal record. Notice of a name change is published in The Ontario Gazette. The Ontario Gazette is the Government of Ontario's official publication which can be searched online. Generally, notice of a name change is published in The Ontario Gazette, however, there are exceptions specified in the Change of Name Act. See Part 5 of the application for more information about the form, what documents to send, police records checks, and publishing of the name change in The Ontario Gazette. 2. Make sure you have the right application form. There are three different forms for changing names: Application to change an adult's name use if you want to change your own name and you are 16 years of age or older and you have lived in Ontario for the last 12 months before sending the application. Application to change a child's name use if you want to change the names of your children who are 17 years of age or younger who have lived in Ontario for the last 12 months before sending the application or since birth if the child is less than one year of age. Name change election use if you want to change your last name because of marriage, divorce or death of your spouse. You may also use it to change your last name while you are living with a person in a conjugal relationship outside of marriage. You can get this form from the Office of the Registrar General. For more information, call 1-800-461-2156 outside Toronto but within North America or 416-325-8305 in Toronto or outside North America, TTY/Teletypewriter (for the hearing impaired) 416-325-3408. 3. Get the right number of application forms. You need a separate application form for each adult and/or child whose name is being changed. 4. Fill in the application. Note: It may take several weeks to gather all the information you need. Allow enough time to complete this application. Print clearly. Use a pen with blue or black ink. Do not use correction fluid on this application. If you fill in information and want to change it later, or if you have made a mistake, you must do the following: Put brackets around the wrong information. Enter the correct information. Put your initials beside each change. The person commissioning this form must also initial each change before it is sworn. See part 6 for more information. There are seven parts to the application. You may not have to use all seven parts. Be sure to read the instructions at the beginning of each part carefully to find out what to do. 5. The fees are: $137 for an adult name change. $ 22 for each name change for a child 17 years of age or younger, using an Application to change a child's name if the name is changed at the same time as one of the child's parents. If the child's name is being changed without a parent, the fee is $137. Fees are subject to change without notice. 6. Mail the documents to the Office of the Registrar General (mailing address listed on the front page of the application). Also include: The certificates/documents listed in Part 5, and the fee. Print your own address on the top left corner of the envelope before mailing. What happens after you send in your application? If your name change is approved, you will get a change of name certificate. It will show your previous name and your new name. You can use this certificate to change your name on other personal documents such as your driver's licence or your credit cards. Every person born in Ontario who changes their name will also get a new birth certificate in their new name. See page 15 for more information about certificates. You must indicate on page 15 if you do not want your sex to be displayed on your birth certificate. If you were born in another part of Canada and want a new birth certificate, you must contact the province or territory where you were born after you get your change of name certificate. 11155E (2018/04) - Application to Change an Adult's Name - Part 1 Page 1 of 17 Part 1 Personal Information A. Information About You (Form 5, Change of Name Act) What is your name now? Note: See instruction notes in Part 5 of this form for information regarding your current legal name before completing this section. First Name Middle Name(s) Last Name or Single Name Mailing Address Street Number and Street Name PO Box or RR Apt/Unit/Suite Buzzer No. City/Town/Village Province Postal Code Daytime Telephone Number Alternate Daytime Telephone Number You must have lived in Ontario for at least 12 months immediately before applying for this name change. You will need a Guarantor who can confirm you meet the residency requirement (Part 4 of this form). Print the number of years and months you have been living in Ontario immediately before this application. Years Months When were you born? Year Month Day Where were you born? City/Town/Village Province or State Country What do you want your new name to be? (You may choose a single name if it is in accordance with your traditional culture. A Single Name Request for Name Change form and supporting evidence must be submitted with this application. See Part 5 of this form for additional information.) First Name Middle Name(s) Last Name or Single Name For office use only. Please do not write anything in this box. Change of Name Registration Number Change of Name Registration Date Approved By 11155E (2018/04) - Application to Change an Adult's Name - Part 1 Page 2 of 17 Information about Current Marital or Relationship Status Are you married now? (Select one box only. If you are separated but not divorced, select the "Yes" box.) No Yes What was your spouse/partner's name before you got married? First Name Middle Name(s) Last Name or Single Name When did you get married? Year Month Day Where did you get married? City/Town/Village Province Country Declaration of Conjugal Relationship Note: Two people who live together in a conjugal relationship (or common law relationship) outside marriage can sign a Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act) to change their last name to their spouse/ partner's last name (Form 1, Change of Name Act). Have you ever signed a document called a Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act) and sent it to the Office of the Registrar General? (Select one box only.) No Go to information about your parents on page 3 Yes What is the name of the other person who signed the Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act) with you? First Name Middle Name(s) Last Name or Single Name When did you send it to the Office of the Registrar General? Year Month Day You can only revoke a Joint Declaration of Conjugal Relationship by completing and sending to the Office of the Registrar General a Declaration that Conjugal Relationship has Ended (Form 4, Change of Name Act). Have you officially revoked the Joint Declaration by submitting Form 4 of the Change of Name Act? (Select one box only.) No Yes 11155E (2018/04) - Application to Change an Adult's Name - Part 1 Page 3 of 17 B. Information about your parents Please provide information about all of the parent(s) listed on your birth registration. Parent Information: Parent's First Name(s) Parent's Middle Name(s) Parent's Current Legal Last Name or Single Name Parent's Legal Last Name or Single Name (at the time of their birth), if different from above Any Previous Legal Last Name(s) or Single Name of the Parent Parent Information: Parent's First Name(s) Parent's Middle Name(s) Parent's Current Legal Last Name or Single Name Parent's Legal Last Name or Single Name (at the time of their birth), if different from above Any Previous Legal Last Name(s) or Single Name of the Parent Parent Information: Parent's First Name(s) Parent's Middle Name(s) Parent's Current Legal Last Name or Single Name Parent's Legal Last Name or Single Name (at the time of their birth), if different from above Any Previous Legal Last Name(s) or Single Name of the Parent Parent Information: Parent's First Name(s) Parent's Middle Name(s) Parent's Current Legal Last Name or Single Name Parent's Legal Last Name or Single Name (at the time of their birth), if different from above Any Previous Legal Last Name(s) or Single Name of the Parent If additional space is needed for parent information, please photocopy this blank page, complete and enclose with the application. 11155E (2018/04) - Application to Change an Adult's Name - Part 1 Page 4 of 17 C. Information about your name change and any previous name changes Why do you want to change your name? Print all of the reasons. Have you ever changed your name before? (Select one box only.) No Yes If yes, when did you change your name? Year Month Day What was your name before you changed it? First Name Middle Name(s) Last Name or Single Name What was your name after it was changed? First Name Middle Name(s) Last Name or Single Name Where was your name changed? Province or State Country If your name was changed more than once, please photocopy this blank page, complete and enclose with the application for every name change. Have you ever applied for a name change before and been refused? (Select one box only.) No Yes 11155E (2018/04) - Application to Change an Adult's Name - Part 1 Page 5 of 17 D. Information about criminal offences To be answered by all applicants Note: Questions 3 and 4 pertain to both Canadian criminal offences and criminal offences committed in other jurisdictions. Question 5 pertains to criminal charges in both Canadian and other jurisdictions. 1. Are you aware of any pending court proceedings against you, other than pending criminal charges? This includes a proceeding that started but has not yet gone to court or has not yet been decided. (Select one box only.) No Yes If yes, complete the following: Court file number: Court name Address of the court Describe the proceedings (e.g. civil, family, provincial offences such as traffic, or other) 2. Are you aware of any outstanding law enforcement orders against you, including any warrant, prohibition order, restraining order, driver's licence suspension, probation order or parole order? (Select one box only.) Note: Select the "No" box and do not provide details if information would reveal you as being a person dealt with under the Youth Criminal Justice Act (unless you were given an adult sentence). No Yes If yes, complete the following: Court file number: Court name Address of the court Describe the proceedings (eg type of lawsuit, etc.) 3. Have you ever been convicted of a criminal offence? (Select one box only.) Note: Select the "No" box if the offence(s) have been pardoned or suspended under the Criminal Records Act (Canada). If providing details of the offence would reveal that you were dealt with under the Youth Criminal Justice Act, select the "No" box, unless: a) If you were convicted of a criminal offence and given an adult sentence (as defined in the Youth Criminal Justice Act); and b) The time frame for taking an appeal has expired or all proceedings in respect of the appeal have been completed and the appeal court has upheld the adult sentence; and c) The record is not required to be destroyed under the Youth Criminal Justice Act. No Yes If yes, please give details of the offence or offences below: 4. Have you ever been found guilty of a criminal offence and not been discharged? (Select one box only.) Note: Select the "No" box below if: You have never been found guilty of a criminal offence More than one year has passed since you were discharged absolutely; or More than three years have passed since you were discharged on the conditions prescribed in the probation order; or Providing details of the discharge would reveal that you were dealt with under the Youth Criminal Justice Act. No Yes If yes, please give details of the offence or offences below: 5. Are you aware of any pending criminal charges against you? This includes a proceeding that has been started but has not yet gone to court or has not been decided. (Select one box only.) Note: Select the "No" box and do not provide details if information would reveal you as being a person dealt with under the Youth Criminal Justice Act. No Yes If yes, complete the following: Court file number: Court name Address of the court Describe the charges If you answered "Yes" to questions 2, 3, 4 or 5, you must provide a current original police records check with this application. Please contact your local police department to arrange for the check and include it with your application. 11155E (2018/04) - Application to Change an Adult's Name - Part 1 Page 6 of 17 E. Financial Information To be answered by all applicants 1. Has any court or tribunal ordered you to pay money that you have not yet paid? (This includes judgements and fines. For example, rent arrears and small claims awards.) (Answer no to this question if as a youth, you were charged under the Youth Criminal Justice Act but not given an adult sentence and you still owe money because of this conviction). (Select one box only.) No Yes If yes, complete the following: Court file number: Court name Date of the court order (year, month, day) Name of the person who sued you Address of the court or tribunal 2. Are you aware if a sheriff has been directed to take your real and personal property to enforce an outstanding judgment, such as real estate, vehicle or furniture? (Select one box only.) No Yes If yes, complete the following: Writ number: Name of sheriff Address of the sheriff 3. Are you aware of any liens or security interests against your personal property; for example, have you agreed that a person can take your possessions if you do not repay a loan or do something you promised to do? (Select one box only.) No Yes If yes, complete the following: Name of the person who has the lien or security interest How much money do you owe? Registration number 4. Are you aware of any financing statements registered under the Personal Property Security Act that name you as a debtor? (There could be a financing statement registered against you if you used personal possessions to get a loan which has not been repaid yet, e.g. a car loan.) (Select one box only.) No Yes If yes, what is the registration number? Registration number 5. Are you an undischarged bankrupt? (You are an undischarged bankrupt if you have not received a discharge from your Trustee in Bankruptcy yet.) (Select one box only.) No Yes If yes, give details of the bankruptcy below: 11155E (2018/04) - Application to Change an Adult's Name - Part 2 Page 7 of 17 Part 2 Giving Notice about Your Name Change You only need to fill in this part if: you are married now, or you signed a Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act) Note: Two people who live together in a conjugal relationship (e.g. common law relationship) outside marriage can sign a Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act). They usually do this so they can legally change their last names to their partner's last name using Form 1, Change of Name Act. If you are not married and did not sign a Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act), do not fill in Part 2. Go to Part 3. If you signed a Joint Declaration of Conjugal Relationship (Form 3, Change of Name Act), but have officially cancelled it by completing and sending to the Office of the Registrar General Form 4 of the Change of Name Act, do not fill in Part 2. Go to Part 3. Here is what to do if you need to fill in Part 2: Notice of this name change must be provided to your spouse or partner as noted in the two examples at the top of this page. Remove this page from the application and complete the top portion of the Notice form on the next page. Provide a copy of this completed Application to Change an Adult's Name and the notice to each person being notified of the name change at least 30 days before submitting the application. If more than one person requires notice, photocopy the blank Notice form and provide a separate notice and a copy of the completed Application to Change an Adult's Name to each person being notified. Send the Notice form and a copy of the application by registered or certified mail to the last known address of each person entitled to notice. Send the original registered mail receipt that includes the name, address and date stamp on it with this application. With this application, submit all original completed and signed notice form(s) as required. If the signed Notice form is not returned to you, submit the original registered mail receipt with the name, address and date stamp on it for each Notice. If the person you send this page to signs the Notice form and sends it back to you, put it with the rest of this application. If you are living with the person and if they fill in and sign the Notice form, you do not have to mail the Notice to them. Include the signed Notice form with the rest of the application that you submit to the Office of the Registrar General. Note: The person you send notice to cannot stop you from changing your name unless they get a court order. 11155E (2018/04) - Application to Change an Adult's Name - Part 2 Page 8 of 17 Notice Form (Form 6, Change of Name Act) The purpose of this form is to let you know that the person listed below has requested a name change. If you sign this form, it does not mean you agree or disagree with the name change. It simply means that you know about it. The Registrar General may proceed with the name change if a signed Notice is not received and the Registrar General is satisfied that the Notice was sent by registered or certified mail to each person entitled to Notice. Please fill in the information below, sign this form and return it to the address of the applicant provided below. If you have questions, please call the Office of the Registrar General at 1-800-461-2156 or 416-325-8305. Print clearly and use a pen with blue or black ink. Do not use correction fluid. If you fill in information and then want to change it later, put brackets around the wrong information and put your initials beside the change. To be filled in by the applicant (the person signing the Statutory Declaration in Part 6 of this application). Notice is hereby given to Print Name of Person Entitled to Notice of an application to change an adult's name under section 5 of the Change of Name Act to change the name as follows: Your current name (enter the full current name exactly as it is listed on page 1 of the application): First Name Middle Name(s) Last Name or Single Name Your new name (enter the full new name exactly as it is listed on page 1 of the application): First Name Middle Name(s) Last Name or Single Name Your Full Mailing Address Signature of Applicant Date Signed (yyyy/mm/dd) Acknowledgement of Notice of a Name Change (to be filled in by the person acknowledging notice of the name change). I, Print Name of Person Acknowledging Notice of the Change of Name of Complete Mailing Address of Person Acknowledging Notice married to/spouse of applicant am or partner who has signed a Joint Declaration of Conjugal Relationship (see help note on previous page) Signature of the Person of Acknowledging Notice Date Signed (yyyy/mm/dd) By signing below, I agree that I have been informed of the proposed change of name. Personal information on this form is collected under the authority of the Change of Name Act, R.S.O. 1990, c.C.7. It will be used to determine whether a change of name can be granted, to register and record the change of name, to publish the change of name in The Ontario Gazette, to provide certified copies of the registration, certificates and search notices and for statistical, research, medical, security and law enforcement, corrections, adoption and adoption disclosure purposes. It is an offence to willfully make a false statement on this form. Questions about this collection should be directed to: The Deputy Registrar General, Office of the Registrar General. PO Box 3000, 189 Red River Road, Thunder Bay ON P7B 5W0. Telephone: Outside Toronto but within North America 1-800-461-2156 or in Toronto or outside North America 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or Fax: 807-343-7459. 11155E (2018/04) - Application to Change an Adult's Name - Part 3 Page 9 of 17 Part 3 Getting Consent to Change Your Name You need to fill in this part only if: you are 16 or 17 years old and you are not married The Change of Name Act requires the written consent of every person with legal custody of a child before the child's name can be changed. This may include: parents or guardians other than the applicant (the child's parents share custody unless a court order or separation agreement states otherwise) someone identified by the court as having custody of the child You must send all original or court certified copies of court orders or separation agreements that name persons who have custody of you. If you are 16 or 17 years old and you are married, you do not need to fill in Part 3. However, you must send us proof that you are married, e.g. a copy of a marriage certificate. With the application, submit all original completed and signed consent form(s) as required. If more than one person is providing consent, photocopy the blank consent form for each person to complete. If someone refuses to sign and return this page to you, you may ask the Ontario Court of Justice for an order allowing you to apply for a name change without the person's consent. If the court gives you such an order, submit the court certified copy of the order with the application when you submit it to the Office of the Registrar General. 11155E (2018/04) - Application to Change an Adult's Name - Part 3 Page 10 of 17 Consent Form (Form 7, Change of Name Act) A legal name change has been requested by the applicant listed below. If you have legal custody of this person or if there is a legal agreement that states consent is required to change the person's name, please complete this form to consent to the name change. Print clearly and use a pen with blue or black ink. Do not use correction fluid. If you fill in information and then want to change it later, put brackets around the wrong information and put your initials beside the change. To be filled in by the applicant (the person signing the Statutory Declaration in Part 6 of this application). Your current name (enter the full current name exactly as it is listed on page 1 of the application): First Name Middle Name(s) Last Name or Single Name Your new name (enter the full new name exactly as it is listed on page 1 of the application): First Name Middle Name(s) Last Name or Single Name Your Date of Birth (yyyy/mm/dd) Your Full Mailing Address To be filled in by the person with legal custody consenting to the name change. I, Print Name of Person Consenting to the Change of Name of Complete Mailing Address of Person Consenting am a person with legal custody of the person listed above and consent to the change of name. Date Signed (yyyy/mm/dd) Signature of Person Consenting Personal information on this form is collected under the authority of the Change of Name Act, R.S.O. 1990, c.C.7. It will be used to determine whether a change of name can be granted, to register and record the change of name, to publish the change of name in The Ontario Gazette, to provide certified copies of the registration, certificates and search notices and for statistical, research, medical, security and law enforcement, corrections, adoption and adoption disclosure purposes. It is an offence to willfully make a false statement on this form. Questions about this collection should be directed to: The Deputy Registrar General, Office of the Registrar General. PO Box 3000, 189 Red River Road, Thunder Bay ON P7B 5W0. Telephone: Outside Toronto but within North America 1-800-461-2156 or in Toronto or outside North America 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or Fax: 807-343-7459. 11155E (2018/04) - Application to Change an Adult's Name - Part 4 Page 11 of 17 Part 4 Proving How Long You Have Lived in Ontario You must have been ordinarily a resident of Ontario for at least 12 months immediately before submitting your change of name application. Part 4 is used to prove you have been ordinarily resident in Ontario for at least the past 12 months. You must find a guarantor who will confirm how long you have lived in Ontario. To be considered ordinarily resident, you must have maintained a residential address, with the intention of that being considered your permanent address in Ontario for 12 consecutive months immediately before making your application. Even if you were born in Ontario, you must still meet the residency requirement before applying. Only absences of a temporary nature are allowed. If you have questions about whether you meet the residency requirement, please contact our office. Any of the following people who know that you have been ordinarily resident in Ontario for at least the past 12 months can be a guarantor: 1. Provincial judges appointed under the Courts of Justice Act. 2. Justices of the peace appointed under the Justices of the Peace Act. 3. Chiefs of Indian bands that are located in Ontario. 4. Persons authorized under the Marriage Act to solemnize marriages. 5. Legally qualified medical practitioners. 6. Members of the Law Society of Upper Canada. 7. Heads of Municipal Councils in Ontario. 8. Clerks of municipalities in Ontario. 9. Principals of elementary and secondary schools, as defined in the Education Act. 10. Managers or signing officers of Ontario branches of banks listed in Schedule I or II of the Bank Act (Canada), loans corporations, trust corporations, credit unions and caisses populaires. The list above is not an endorsement by the Office of the Registrar General of professional status or recognition of superior qualifications. If you can't identify anyone from this list to act as a guarantor, you must find someone other than a relative who has known you for at least five years, and knows that you have ordinarily resident in Ontario for at least the past 12 months. Remove the Guarantor's Statement from the application and ensure all sections are fully completed before submitting. The applicant will complete the top section and the guarantor will complete the bottom section. 11155E (2018/04) - Application to Change an Adult's Name - Part 4 Page 12 of 17 Guarantor's Statement (Form 8, Change of Name Act) The person named below as the applicant is applying for a legal name change. The purpose of this form is to prove that this person has been ordinarily resident in Ontario for at least the past 12 months. Please completely fill in the information below and return this page to the person applying for the name change. Print clearly using blue or black ink. If you fill in information then want to change it later, put brackets around the wrong information and put your initials beside the change. Do not use correction fluid on this application. To be filled in by the applicant (the person signing the Statutory Declaration in Part 6 of this application). Your current name (enter the full current name listed on page 1 of the application): First Name Middle Name(s) Last Name or Single Name To be filled in by the guarantor. Name of the guarantor: First Name Middle Name(s) Last Name or Single Name Mailing Address: Street Number and Street Name Apartment/Unit/Suite/PO Box/RR City/Town/Village Province Postal Code What is your usual occupation? How long have you known the person named at the top of this page? (list the month and year) Since: Month (mm) Year (yyyy) How long has the person listed at the top of this page been ordinarily resident in Ontario? (list the month and year) Since: Month (mm) Year (yyyy) Signature of Guarantor Date Signed (yyyy/mm/dd) Personal information on this form is collected under the authority of the Change of Name Act, R.S.O. 1990, c.C.7. It will be used to determine whether a change of name can be granted, to register and record the change of name, to publish the change of name in The Ontario Gazette, to provide certified copies of the registration, certificates and search notices and for statistical, research, medical, security and law enforcement, corrections, adoption and adoption disclosure purposes. It is an offence to willfully make a false statement on this form. Questions about this collection should be directed to: The Deputy Registrar General, Office of the Registrar General. PO Box 3000, 189 Red River Road, Thunder Bay ON P7B 5W0. Telephone: Outside Toronto but within North America 1-800-461-2156 or in Toronto or outside North America 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or Fax: 807-343-7459. 11155E (2018/04) - Application to Change an Adult's Name - Part 5 Page 13 of 17 Part 5 Application and Documents to be sent A. Review of the documents to be sent Generally, the name you are entitled to be recognized by can be determined as follows: If you were born in Ontario, you are entitled to be recognized by the name listed on your birth certificate If you were born in Ontario and legally changed your name in Ontario, you are entitled to be recognized by the name on your change of name certificate If you were born outside of Ontario, you are entitled to be recognized by the name recognized in law in the last place you had a real and substantial connection before residing in Ontario If after coming to reside in Ontario, you legally changed your name in Ontario, you are entitled to be recognized by the name on your change of name certificate The proof of your current legal name to send with your application is described below: If you were born in Canada (including Ontario), your current legal name will generally be the name listed on your birth certificate issued by the province or territory where you were born. Please send the following: if you were born in Ontario, send all previously issued original birth certificates or certified copies of birth registration (long form birth certificates) if you were born outside Ontario but within Canada, submit either an original birth certificate or certified copy of birth registration (long form birth certificate) if you do not have a birth certificate, apply for a birth certificate and submit the certificate with this change of name application If you were born outside of Canada, we require documents that show your legal name before you came to live in Ontario. If you have ever legally changed your name, provide proof of the legal name change. If there are differences in your name, date of birth or place of birth between your identity documents, you will be asked to provide additional consistent proof of your identity information. Include a detailed written explanation stating where, when and how the information was changed on each document and what supporting documents were used to make the changes. Please send the following documents: photocopy of original birth certificate or photocopy of certified copy of birth registration from country of birth and; photocopy of Canadian Citizenship Card/Certificate (both sides) or photocopy of Canadian Record of Immigrant Landing or photocopy of Permanent Resident Card (both sides) and; photocopy of the passport used to enter Canada (if still held by the applicant) If applicable, all applicants are required to send: photocopies of all change of name certificates or change of name documents if you have had your name legally changed before (within Canada or outside Canada) all court certified copies of court orders that relate to custody, access or naming of the person whose name is being changed If you were born outside of Canada and for some reason you cannot obtain a photocopy of your birth certificate issued by the country in which you were born, include a signed written explanation as to why you are unable to provide it and what you have done to try to obtain it. Translations of documents that are not in English or French If all or part of a document sent in support of your change of name application is not written in English or French, you must send us an English or French translation. If a translation is required, your application must include: a complete photocopy of the document requiring translation; a complete photocopy of the translation of the original document; and an original written declaration from one of the following: 1. A professional translator, who indicates their professional status as a translator (this declaration is not required to be sworn); or 2. A person who is not a professional translator (this declaration must be sworn in front of a commissioner for taking affidavits). The translator's original written declaration must state: The translator understands English or French and the language of the original document; and The translator is of the opinion that the translation is complete and correct. If the translator's declaration is written on the translation of the original document, the translation must be submitted in its original form. A photocopy will not be accepted. 11155E (2018/04) - Application to Change an Adult's Name - Part 5 Page 14 of 17 Part 5 Application and Documents to be sent B. Review of the contents of the form Please review the information below to ensure you complete and submit all parts of the form and documents that apply to this application. Submit all pages of the application regardless of whether some of the pages do not apply to you. Part Title of Section Information about the Section(s) Who Must Complete Part 1 Personal Information Sections A to E All sections to be completed by everyone Part 2 Giving notice about your name change Notice Form signed by the applicant and either: a) the person they are married to or; b) a person with whom they have signed a form called a Joint Declaration of Conjugal Relationship. Only required if the applicant is currently married, or has signed a Joint Declaration of Conjugal Relationship form with the Office of the Registrar General. Part 3 Getting consent to change your name Consent Form signed by the applicant and their parent(s), guardian(s) or anyone who has legal custody of the applicant. Only required if the applicant is 16 or 17 years old and is not married. Part 4 Providing how long you have lived in Ontario Guarantor's Statement to be completed by the applicant and the guarantor Required for everyone Part 5 Application and documents to be sent Review and send applicable documents listed in Part 5, sections A and B. Required for everyone Part 6 Signing your application Statutory Declaration form signed by the applicant and the commissioner. All errors on the form must be bracketed and initialed by the applicant and the commissioner. Required for everyone Part 7 Payment Fee is paid by VISA, MasterCard, money order or cheque. It is payable to the Minister of Finance. Do not send cash, stamps or pre-paid envelopes. Required for everyone Additional evidence to support a change of name application may be required. Photocopies of additional evidence may be acceptable however, this office reserves the right to request original or certified copies. Applications that do not contain the requested documentation will be returned to the applicant as incomplete and will cause a delay in processing. Single Name Request You may choose a single name if it is in accordance with your traditional culture. A separate request using a Name Change to a Single Name form with supplemental evidence must be completed and submitted with this application. This form and information about single name evidence may be obtained by contacting our office by telephone outside Toronto but within North America at 1-800-461-2156 or in Toronto or outside North America at 416-325-8305. TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or by fax at 807-343-7459 or online through our website at ServiceOntario.ca. Police Records Checks If you answered yes to questions 2, 3, 4 or 5 in Part 1, Section D of this form, then you are required to obtain and submit a currently issued original copy of a police record check. If you must obtain a police record check, please contact your local police department to arrange for the check and include it with the application. After the name change application is received, identifying information about every person 12 years of age and older whose name may be changed by this application is given to the Ministry of Community Safety and Correctional Services to be checked against the Canadian Police Information Centre (CPIC) records. If you have any questions regarding the police records check, please contact the Ministry of Community Safety and Correctional Services at 416-326-5010. Publication of Name Changes in The Ontario Gazette The Change of Name Act requires that notice of a legal name change under this Act be published in The Ontario Gazette. There is an exception to this requirement for transgender individuals who request that notice of their name change not be published. Notice of name changes are published in The Ontario Gazette can be searched online at Ontario.ca/Gazette. You can submit a completed form requesting non-publication of your change of name with your application. The form must be submitted with the change of name application in order to be considered. The form is available by mail or online through our website at ServiceOntario.ca. To have the form mailed contact our office by telephone outside Toronto but within North America at 1-800-461-2156 or in Toronto or outside North America at 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408. 11155E (2018/04) - Application to Change an Adult's Name - Part 6 Page 15 of 17 Part 6 Signing Your Application Before you send us your application, you must first sign the next page. You must sign this statement in front of a person called a commissioner for taking affidavits. The statement says you have followed all the steps and all the information is true. It is a serious crime under the Criminal Code of Canada to make a false statement. There are commissioners in every community who will provide this service. Here are some examples of commissioners: a member of the Legislative Assembly of Ontario clerks, deputy clerks and treasurers of local municipalities a lawyer entitled to practice law in Ontario provincial judges and justices of the peace Here's what to do 1. Make sure all documents you need are filled in and signed by the necessary people. Refer to the Application and Documents to Be Sent part of the form in Part 5 (B) to confirm you have what you need. 2. Make sure you have included with your application all the birth certificates and other documents as explained in Part 5. 3. Bring the application and all of the documents to the commissioner. Sign at the X on the next page in front of the commissioner. 4. The commissioner will fill in and sign the Statutory Declaration form on the next page. 5. Make sure the commissioner puts his or her initials beside any changes or corrections you have made on the application. This includes changes made to Forms 5, 6, 7 or 8. Documents You Will Receive If your name change is approved, you will get a change of name certificate. It will show your previous name and your new name. You can use this certificate to change your name on other personal documents such as your driver's licence or credit cards. Every person born in Ontario who changes their name will also get a new birth certificate in their new name. The birth certificate automatically issued does not contain parental information. If you wish to apply for a birth certificate with parental information or a certified copy of the birth registration, you can do so by submitting a Request for a Birth Certificate application and the associated payment along with this form, or at a later date (after the name change is completed). An Ontario birth certificate is an extract of a person's birth registration. Sex (M, F, or X) as it is recorded on a person's birth registration will be displayed on the certificate, unless you indicate that you do not want it displayed by selecting the box below: I do not want sex to be displayed on this birth certificate. Note that this request will not change or amend the birth registration. Disclaimer: The Government of Ontario cannot guarantee that a birth certificate with no sex displayed will be accepted by organizations in Ontario or by other jurisdictions. 11155E (2018/04) - Application to Change an Adult's Name - Part 6 Page 16 of 17 Part 6 Continued Statutory Declaration Form To be signed by the person applying for the name change. By signing this Statutory declaration form, I declare that I have followed all the rules and provided all the documents needed for this name change application. I declare that every consent specified in this application has been obtained or dispensed with by the court. I declare that every notice specified in this application has been given. I declare that I have been ordinarily resident in Ontario for at least one year immediately before making this application. I declare that I am not making this application for any improper purpose. I declare that the information I have given in this application is true and complete. I, (print name of applicant) make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath. Must be signed in front of a commissioner for taking affidavits. Signature of Applicant X Declared before me at the (municipality where declaration made) of (county, district or regional municipality where declaration made) this day day of Month , 20 year . Commissioner for taking Affidavits Signature Commissioner's seal/stamp Or state occupation/authority to commission 11155E (2018/04) Page 17 of 17 Payment Method and Credit Card Authorization Applicant's Information Last Name or Single Name First Name Middle Name(s) Subject's Information Last Name or Single Name First Name Middle Name(s) Fees Select the appropriate box(es): Adult name change - $137.00 How many? Child name change at same time as adult - $22.00 How many? Child name change only (not being done with an adult name change) - $137.00 How many? Total of authorized payment included $ All applications: Ensure the correct fee along with all forms, evidence and all original certificates are submitted. We do not accept cash as payment for any type of application. If your application is returned for any reason, you must resubmit your credit card payment information (if used), as it will be shredded for privacy and security reasons. Fees are subject to change without notice. Applications made within Canada: Send your request by mail and pay by cheque, money order (made payable to the Minister of Finance), VISA or MasterCard. Post-dated cheques are not accepted. An administration fee of $35.00 will be applied to any cheques returned by a Financial Institution. Applications made outside Canada: If you are sending your payment from anywhere other than Canada, you must pay with an international money order in Canadian funds drawn on a Canadian clearing house, or by VISA or MasterCard. For assistance: Please visit ServiceOntario.ca or contact us at: Telephone: outside Toronto but within North America 1-800-461-2156 or in Toronto or outside North America 416-325-8305. TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or Fax 807-343-7459. Method of Payment - Check the box with your method of payment for this application Medium Sensitivity VISA MasterCard Cheque Money Order If paying by cheque or money order, please make payable to the Minister of Finance Credit Card Information Print Name of Cardholder (as it appears on the credit card) Name of Credit Card Company Credit Card Number Expiration Date yy mm Signature of Cardholder and/or Signing Authority Date (yyyy/mm/dd) Year Day Month Personal information on this form is collected under the authority of the Change of Name Act, R.S.O. 1990, c.C.7. It will be used to determine whether a change of name can be granted, to register and record the change of name, to publish the change of name in The Ontario Gazette, to provide certified copies of the registration, certificates and search notices and for statistical, research, medical, security, law enforcement, corrections, adoption and adoption disclosure purposes. It is an offence to willfully make a false statement on this form. Questions about this collection should be directed to: The Deputy Registrar General, Office of the Registrar General, PO Box 3000, 189 Red River Road, Thunder Bay ON P7B 5W0. Telephone: Outside Toronto but within North America 1-800-461-2156 or in Toronto or outside North America 416-325-8305, TTY/Teletypewriter (for the hearing impaired) 416-325-3408 or Fax: 807-343-7459.

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