Change of surname declaration template for a minor child in case of a change of parentage (Document template)

Warning

The 2 parents must be present when the declaration is submitted to the registrar.

We, the undersigned,

Tableau - Identity of parents
Identity of parents	mother/father	father/mother
Last name	[A unique or dual name composed of the name of both parents]	[A unique or dual name composed of the name of both parents]
First name(s)
Date of birth
Place of birth
Home

say that our common child:

First name(s):

Date of birth:

Place of birth:

Home:

now takes the name of

Tableau - Name Choice: Distinguished Name
Distinguished Name
[Distinguished Name]

[Or]

Tableau - Choice of name: double name
Dual Name
[Part 1] - [2nd part]

Tableau - Signature of parents
mother/father	father/mother
TO [location] , on [date] Signature:	TO [location] , on [date] Signature:

FYI

This name will also be that of our other common children.

Verified 13 May 2024 - Directorate for Legal and Administrative Information (Prime Minister)

For details, please use the practical information sheets :

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.