Vsa 529 Form – Fill Out and Use This PDF

APPLICATION FOR CHANGE OF NAME

UNDER THE PROVISIONS OF THE BRITISH COLUMBIA NAME ACT

Are there situations when I should legally change my surname after marriage?

•Yes, if you want to update your immigration or citizenship documents to reflect a new name or a married surname.

Take into consideration that if you were born in B.C., changing your surname legally will change your surname on your birth certificate and your current marriage certificate. If you were born or married outside of B.C. but within Canada, contact your birth/marriage province to find out how it will affect your records.

How to Fill Out the Application for Change of Name

➊ELIGIBILITY - Eligible applicants are:

1.Age 19 or older. Note - If you are under 19 but are a parent with custody of your child, you may apply to change your name or that of your child, without consent from your parent(s).

2.Changing their own name, or are a parent changing the name of their minor child(ren) (18 years of age or younger).

3.Currently living in B.C. and have done so for at least three months immediately prior to the date of application.

➋COMPLETING THIS FORM

Select the pages you need to complete using the table below as a guide. If you fill out the form by hand, print clearly and use

black or blue ink only. Applications completed with pencil will not be accepted. If you are including more than one child in your application, photocopy or print additional copies of applicable pages in Part 2.

If you are...	Then fill out...
An adult (19 years of age or older) changing your name	 Part 1A (pg 5) and Part 1B (pg 6).
only	 Fees section (pg 3).
	 Search Application (pg 4) only if missing a B.C. birth or marriage document.
A parent changing BOTH your name AND the name of	 Part 1A (pg 5) and Part 1B (pg 6) with your information - not your child’s.
your child(ren) who is/are 18 years of age or younger	 Part 2A and 2B (pg 7-8). Complete a separate Part 2A and 2B for each child
	included in the change of name application.
	 Pages 9 and 10 (if you are requesting a waiver of parental consent).
	 Fees section (pg 3).
	 Search Application (pg 4) only if missing a B.C. birth or marriage document.
A parent and are NOT changing your own name, but	 Part 1A (pg 5) and Part 1B (pg 6) with your information - not your child’s.
ARE changing the name of your child(ren) who is/are	 Part 2A and 2B (pg 7-8). Complete a separate Part 2A and 2B for each child
18 years of age or younger	included in the change of name application.
	 Pages 9 and 10 (if you are requesting a waiver of parental consent).
	 Fees section (pg 3).
	 Search Application (pg 4) only if missing a B.C. birth document.

How do I get a certified copy of a document?

Take the original document to an authorized person listed in step ➍ on page 3. The authorized person will photocopy the original, then certify that it is a copy of the original document by stamping and signing it. (For a fee of $17, a Service BC representative will witness your signature on the statutory declaration and certify any original documents that are required to be submitted with your application. To find a location near you, visit http://www.servicebc.gov.bc.ca.)

TIP: The same person who witnesses your signature on the statutory declaration(s) required for your application can provide you with certified copies. Signatures and certified copies are valid for six months only.

VSA 529 2018/10/22

Page 1 of 10

➌SUPPORTING DOCUMENTS

Submit ALL the supporting documentation that applies to your situation.

TIP: Highlight or put a check mark next to documents that you need to include with your application.

	Were born in Canada	All original birth certificates with a registration number.
	Were born outside of Canada	Certified copies of BOTH sides of your MOST RECENTLY ISSUED Permanent
		Resident Card or Canadian Citizenship Card/Certificate.
	Have changed your name before	All original Canadian change of name certificates.
		All original British Columbia marriage certificates with a registration number
	Got married in British Columbia (not applicable if divorced or widowed)	or a photocopy if the marriage certificate already lists the exact proposed
		name. NOTE - We CANNOT accept commemorative certificates, marriage
		licences, or certificates issued by a church.
	Got married in another Canadian province (not including B.C.)	A photocopy of a marriage certificate is only required if it explains the use of a
		surname on a document submitted or written on your application.
	Got married outside of Canada	A photocopy of a marriage certificate is only required if it explains the use of a
		surname on a document submitted or written on your application.
		A photocopy of the receipt provided by the official who took your fingerprints
	For all adult applicants	electronically. The date on the receipt must be within 30 days of the
		date your application is received in our office.
		A photocopy of your picture ID.

	And the child(ren) was/were born in Canada	All original birth certificates with a registration number and showing
		parentage.
		Certified copies of the following:
		 BOTH sides of each child's MOST RECENTLY ISSUED Permanent
	And the child(ren) was/were born outside of Canada	Resident Card or Canadian Citizenship Card/Certificate.
		 Birth certificate or adoption papers from the country of birth showing
		parentage. Provide certified English translations if these are not in
		English.
	Have documents that are not in English	Certified English translation of the documents.
	And the name either parent uses now is different from the one listed on	Documentation showing how you came to have your current name. (i.e.
	your child(ren)’s birth certificate	marriage certificates, change of name certificates, letter of explanation.)
	And you are married	A photocopy of your marriage certificate.
	Have changed the name of your child(ren) before	All original Canadian change of name certificates.
	For each child 12 to 18 years of age	A letter handwritten in ink by your child(ren) providing his/her reasons for
		wanting a change of name. Have each child sign and date his/her letter. Each
		child 12-18 must also sign in Part 2A - Child's Consent.
	All parents	A photocopy of picture ID (e.g. driver's licence) for all parents listed on each
		child's birth registration showing their current addresses. The applicant's
		address must match the residential address on Part 1A (page 5).

Important Information for Parents Changing the Name of Children (18 or Younger)

Who Can Apply as a Parent?

A person who is legally documented on a birth certificate as a parent of the child. Legal guardianship is not sufficient.

Consent of the Other Parent/Guardian(s) When Changing the Name of Children 18 Years of Age and Younger

If the other parent/guardian(s) will not or cannot provide consent, you must request that Vital Statistics waive their consent. Review Obtaining a Waiver of Parental Consent on pages 9 and 10 for information about requesting a waiver.

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VSA 529 2018/0/22

➍STATUTORY DECLARATION

Sign the statutory declaration(s) in front of one of the authorized persons listed below:

•Service BC representative (For a fee of $17, a Service BC representative will witness your signature on the statutory declaration and certify any original documents required to be submitted with your application. Visit http://www.servicebc.gov.bc.ca for locations.)

•Practicing lawyer or articled law student

•Notary public

•Individual appointed by the Attorney General as a commissioner for taking affidavits

Note - These individuals charge for their services and their fees can vary. All applicants must sign the statutory declaration on page 6 at the same time as it is certified. Dates signed must match. Any parent applicant using the statutory declaration on page 9 must also sign at the same time that it is certified. Statutory declarations are valid for six months only.

➎ FINGERPRINTING

Anyone who is BOTH 18 years of age or older AND changing his or her name must have fingerprints taken as part of a criminal record check - Name Act (RSBC 1996 c. 328). PARENTS - If you are changing the name of your child(ren) only and not your own name, you do NOT need to get your fingerprints taken.

Where can I have my electronic fingerprints taken?

•Most RCMP detachments

•Vancouver Police

•Victoria Police

•Any RCMP-accredited fingerprinting company or its affiliate who submit fingerprints electronically for the purposes of criminal record checks. For a list of accredited companies, visit: http://www.rcmp.gc.ca/en/where-do-get-a-criminal-record-check.

What do I submit with my Change of Name Application?

Fingerprinting officials collect a fee for taking fingerprints in addition to the criminal record check fee of $25, and will provide you with a

receipt for your payment. Include a photocopy of the original receipt given with your application.

Important Notes

 Fingerprints are only used for the purpose required by the Name Act and confirmation of the criminal record check should be returned to the applicant directly from the RCMP.

 Do NOT send Vital Statistics a copy of your fingerprints or criminal record check results.

 The date on the receipt must be within 30 days of the date your application is received in our office.

➏ PAYMENT & FEES

Submit payment for your application in Canadian funds using the table below to calculate the amount owed. Fees below do not include the cost of obtaining certified copies or translations, having your signature witnessed on a statutory declaration, or replacing documents following the change of name.

 Adult (19 years of age or older)

$

137

Name Change Fee

 Adult (19 years of age or older) with dependent child (18 years old or younger)

$

137

Name Change Fee

$

27

For each child

 Child only (18 years of age or younger)

$

137

Name Change Fee for first or only child

$

27

For each additional child

 Birth Search (Fill out application on page 4.)

$

27

For each search (B.C. events only)

 Marriage Search (Fill out application on page 4.)

$

27

For each search (B.C. events only)

Payment Method:

 MasterCard  American Express

 Certified Cheque (No personal or postdated cheques)  Money Order  Visa

Amount

Interac/Cash payment may be made in person

X

at any Service BC office. If paying by certified

$

Card holder signature

Enclosed

cheque or money order, make payable to the

Minister of Finance.

PRINT card holder name as shown on credit card

Note: Credit card information is not retained. Upon authorization of

Expiry date

the payment request, all credit card information is destroyed.

Credit Card #

Applications missing information or documentation are held for 90 days. If you do not respond to a request for information within 90 days, your file will be cancelled and the fee of $137 will be retained to cover the cost of processing your application to date.

➐SUBMIT YOUR APPLICATION

Place all documentation and the completed application into a suitably-sized envelope and submit it with payment in person at a

Service BC office or by mail to the address below:

Vital Statistics Agency

ATTN: CONFIDENTIAL SERVICES	For your nearest Service BC location, visit:
PO Box 9657 Stn Prov Govt	http://www.servicebc.gov.bc.ca
Victoria BC V8W 9P3

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Search Applications for Birth or Marriage Events that Occurred in British Columbia

If you do not have an original birth or marriage certificate to submit with your Application for Change of Name, you can request that Vital Statistics search for the event instead of ordering the certificate if the birth and/or marriage occurred in British Columbia. Simply fill out the application(s) below and then check the box(es) beside Search Fee $27 when completing the Application for Change of Name. Include $27 for each search requested when you are submitting your application.

If you need Vital Statistics to search BIRTH events for several people in a family (e.g. Mom, plus one or more children), photocopy or print additional copies of this page. A search application must be completed for each person requiring a search for a BIRTH event.

Please search for the following BIRTH event that occurred in British Columbia:

Full name of person named in birth event, as listed at time of birth or following a previous change of name (NOT a married surname)
Surname (Last Name)	First Name	Middle Name(s)

Please search for the following MARRIAGE event that occurred in British Columbia:

Spouse's Last Name (at the time of marriage)

Spouse's First Name

Spouse's Middle Name(s)

Spouse's Birthplace (City, Province/State, Country)

General Information

After your change of name application has been processed:

•Vital Statistics will send a Certificate of Change of Name to your mailing address. This certificate will show your previous name as provided

in your foundation identity document, and your new name. If you have included your child(ren) in your application, their names will also be listed on the certificate.

•Your Canadian birth certificate will be amended to list your new name. If you were born in Canada, you will need to order a new birth certificate from your birth province. Be sure to advise them of your recent change of name when placing the order for your new certificate(s). BC Vital Statistics will send an electronic notification to other provinces following the registration of a change of name.

Note - Certificates issued in British Columbia are printed in uppercase lettering only.

•If you were married in Canada, your name change may affect your current marriage certificate. Contact your marriage province for advice.

A name change does not affect a surname assumed by marriage.

•You are responsible for notifying other agencies of your name change and for replacing all applicable documents and identification, such as your BC Driver’s Licence or BC Identification card, BC Services Card, Canadian Passport, etc.

What happens to documents submitted with your application?

Document	Returned	Not Returned
B.C. and other Canadian birth certificates		Destroyed
B.C. marriage certificates		Destroyed
Certificates from previous name change(s)	aStamped with "Historical Document. Not to be accepted as proof of current legal name."
Out-of-province marriage certificates	a
Certified documents (e.g. copies of immigration papers)		Kept on file

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VSA 529 2018/0/22

Part 1 (A) — Adult or Parent Information

APPLICATION FOR CHANGE OF NAME

Adult’s full name as currently listed on birth certificate, most recently issued immigration or citizenship documents,or change of name certificate. (NOT YOUR SURNAME BY MARRIAGE)

Surname (Last Name)

First Name

Middle Name(s)

Full name as you would like it to appear following the legal change of name (Leave this line blank if you are not changing your name.)

Surname (Last Name)

First Name

Middle Name(s)

Personal Health Number (PHN) (Used to confirm residency in B.C.)

How can we

Phone No. (including area code)

Alternate

Phone No. (including area code)

Preferred

Preferred

contact you?

Contact

Email

Number

Number

Address

Place(s) of residence for last three months (ALL fields must be completed)

Suite/Apt No.		Street No.		Street Name			MMM	DD		YYYY
						From
City/Town				Province	Postal Code
				B.C.		To	PRESENT
Suite/Apt No.		Street No.		Street Name			MMM	DD		YYYY
						From
City/Town				Province	Postal Code		MMM	DD		YYYY
				B.C.		To
Address for Letters or Certificate
Mail to:	 Above Address			 Alternate Address Below: (if different from above)

Name/Organization

City/TownProvince/State, CountryPostal/ZipCode

Documentation (Check applicable for each section.)			Notes	Office Use Only
Proof of	If born in Canada - Original birth certificate with a registration number.		Provide certified copies of
	 Enclosed		BOTH sides of your MOST
Birth	 $27.00 Search Fee	(If you were born in British Columbia and do not have a birth	RECENTLY ISSUED
		certificate, complete a Search Application on page 4.)	Permanent Resident Card or
	If born outside of Canada - Certified copy of immigration or citizenship documents.		Canadian Citizenship Card/
			Certificate.
	 Enclosed
	Marriage certificate with registration number (not applicable if divorced or widowed).  N/A
	 Original enclosed	(If married in B.C.)	If you are changing your child’s
	 Photocopy enclosed (If married outside of B.C, a photocopy may be required to show continuity of
Proof of			surname to that of your spouse,
	usage of names.)
Marriage			provide a photocopy of your
	 Photocopy enclosed (If B.C. marriage certificate already lists your exact proposed name.)
			marriage certificate.
	 $27.00 Search fee	(If you were married in B.C. and do not have a marriage certificate,
		complete a Search Application on page 4.)
Proof of	Photocopy of the receipt you received from the fingerprinting agency for electronic fingerprinting (18		If you are 18 years of age or older,
	years of age or older).  N/A		provide a photocopy of the receipt
Electronic
	 Enclosed - The date on the receipt must be within 30 days of the date your		for your payment for electronic
Fingerprinting
	application is received in our office.		fingerprinting.
Previous	Have you previously had a legal change of name in Canada?		Returned to you stamped with:
	 No		"Historical Document. Not to be
Name Change	 Yes - The original Canadian change of name certificate(s) is/are enclosed.		accepted as proof of current legal
	 Yes - I do NOT have the original Canadian change of name certificate(s).		name".
VSA 529 2018/10/22				Page 5 of 10

Part 1 (B) - Adult or Parent Information

APPLICATION FOR CHANGE OF NAME

Statutory Declaration

	r I am applying as a single applicant to change my name only. Complete Section 2.
Check applicable:	r I am a parent applying for myself and my child(ren)'s name change(s). Complete Sections 1 & 2.
	r I am a parent applying on behalf of my child(ren) only. I am not changing my name. Complete Sections 1 & 2.
	Section 1 - To be completed by the applicant parent

!Only a parent recognized on the child's birth certificate or those being listed on the child's immigration documentation can apply to change a child’s name. However ALL PARENTS and/or CUSTODIAL GUARDIANS must sign consent to a child’s name change.

Write your INITIALS beside any/all situations that apply to you:

I have included all custodial/guardianship court order(s) for my child(ren) within this application.

The court order(s) included is(are) a final order OR the court order(s) included is(are) still valid and in effect.

List any future court dates:

OR

I do not have any custodial/guardianship court order(s) for my child(ren).

The other parent was not recorded on the child(ren)'s birth restration(s) and there is no custodial/guardianship court order in place for my child(ren). The other parent and I are still married and there is no custodial/guardianship court order in place for my child(ren).

The other parent and I were married but no longer live together, and there is no custodial/guardianship court order in place for my child(ren). The other parent and I were never married and there is no custodial/guardianship court order in place for my child(ren).

Section 2 - To be completed by ALL applicants

I ____________________________________________________ have read the application and to the best of my knowledge, information and belief, the statements made are true

Applicant's full name

in substance and in fact.

AND

I understand that any documentation submitted to support this application may be verified for validity and/or authenticity with the issuing authority and I provide my consent to the Vital Statistics Agency to complete this verification.

AND

I understand that the Vital Statistics Agency must use the exact name recorded on my birth certificate, immigration or citizenship document, or change of name certificate, and if I record

a name other than that name on my application form the Vital Statistics Agency will amend my application to match.

AND

I have enclosed all original birth certificates, marriage certificates (B.C. only) and historical change of name certificates in my possession and I understand that any Canadian birth certificates and B.C. marriage certificates will not be returned on completion of the name change.

AND

I understand that all previously issued birth certificates, B.C. marriage certificates and change of name certificates will be cancelled under Section 40.1 (1)(h) of the Vital Statistics Act, and that to use any cancelled certificates may constitute a fraudulent action.

AND

I 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.

Documentation		Notes	Office Use Only
	Photocopy of applicant's picture ID (e.g. driver's licence) showing their current address.	The address listed on
All	A copy of a recent utility bill in the applicant's name (e.g. BC Hydro bill) is	the applicant's picture ID
	acceptable proof of the current address if it is not listed on identification.	must match the residential
Applicants	 Photocopy of picture ID is enclosed	address provided in
		Part 1A on page 5.

This information is collected by the Vital Statistics Agency under section 26(c) of the Freedom of Information and Protection of Privacy Act, and will be used to fulfill the requirements of the Vital Statistics Act for the release of change of name information. Should you have any questions about the collection of this personal information, please contact:

Manager, Vital Statistics Agency, 250 952-2681, PO Box 9657, Stn Prov Govt, Victoria BC V8W 9P3

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VSA 529 2018/0/22

Part 2 (A) - Child’s Information (18 Years of Age or Younger)

APPLICATION FOR CHANGE OF NAME

Child’s full name as currently listed on birth certificate, most recently issued immigration or citizenship documents, or change of name certificate

Surname (Last Name)First NameMiddle Name(s)

Child’s full name as it will appear following the legal change of name (Names on Part 2A and Part 2B must match exactly.)

Surname (Last Name)

First Name

Middle Name(s)

Has your child previously had a legal change of name in Canada? (Check applicable)

No

Yes - ALL original Canadian change of name certificates are enclosed.(This certificate will be stamped "Historical Document. Not to be accepted as proof of current legal name" and and will returned to you upon completion of this application.)

Yes - I do NOT have the original Canadian change of name certificate(s).

Indicate what identification you have enclosed to prove your child’s parentage
Child born in Canada:	Child born outside of Canada - CERTIFIED COPIES of:
 Original Canadian birth certificate showing parentage
	 BOTH SIDES of child’s MOST RECENTLY		ISSUED Permanent Resident Card or
 $27.00 Search fee (My child was born in British Columbia but I do not have	Canadian Citizenship Card/Certificate
their birth certificate. I have completed a Search Application on page 4)	 Child's original birth certificate showing parentage
	 English translation of birth certificate if not in English

I request that the consent of the other parent/guardian(s): ____________________________________________________ be waived for the following

reason(s):

Last Name(s)

First Name(s)

A  The other parent/guardian(s) cannot be located after a reasonable, diligent and adequate search has been conducted as demonstrated by statutory declaration and supporting evidence maintained in the change of name file. A custody or guardianship order is required for this option. Obtain an order prior to making application.

B The other parent/guardian(s) is/are deceased, proven by a copy of a government-issued death certificate maintained in the change of name file.

C  The other parent/guardian(s) is/are unreasonably withholding consent to the change of name.
D  The other parent/guardian(s) is/are mentally disordered, as demonstrated by statutory declaration and supporting evidence.
E 	Exceptional circumstances make it unreasonable to seek the consent of the other parent/guardian(s). Unless you can provide a valid court ordered restraining
	order/no contact order between the other parent/guardian(s) and the child(ren) this option does not apply.
	Applicant
	Signature X			Date
					MMM DD			YYYY

CONSENT OF SPOUSE OF APPLICANT (Only if Child’s surname is changing to that of the Applicant’s Spouse.)

I, __________________________________________________________________, am the spouse of the applicant and hereby give my consent for the above-listed child to

Name (Printed)

VSA 529 2018/10/22

Page 7 of 10

Part 2 (B) - Consent of Other Parent/Guardian(s)

APPLICATION FOR CHANGE OF NAME

If more than one child is included in the change of name application, or if there is more than one other parent/guardian, please photocopy or print additional copies of this page.

Full name(s) of other parent/guardian(s) as listed on the birth registration of child or within court orders.

Surname (Last Name)							First Name	Middle Name(s)
Suite/Apt No.				Street No.		Street Name		City/Town
Province/State, Country							Postal/Zip Code	Phone No. (including area code)
Child’s full name as it will appear following the legal change of name (Names on Part 2A and Part 2B must match exactly.)
Surname (Last Name)							First Name	Middle Name(s)
Child's date of birth						Sex	Child's place of birth
MMM		DD			YYYY		City/Town	Province/State, Country

Anyone can witness the signature of the other parent/guardian(s), but the other parent/guardian(s) and the witness must sign at the same time. Signatures are valid for six months only.

Consent of Other Parent/Guardian(s)

I

have read the information provided on this page and to the best of my

Name(s) of Other Parent/Guardian(s)

knowledge, information and belief, the statements made are true in substance and in fact.

AND

I understand that any documentation submitted to support this application may be verified for validity and/or authenticity with the issuing authority and I provide my consent to the Vital Statistics Agency to complete this verification.

AND

I have enclosed all original birth certificates and historical change of name certificates in my possession for each child named in this application. I understand that any Canadian birth certificates will not be returned on completion of the name change.

AND

I understand that all previously issued birth certificates and change of name certificates for each child named in this application will be cancelled under Section 40.1 (1)(h) of the Vital Statistics Act, and that to use any cancelled certificates may constitute a fraudulent action.

AND

I understand that by consenting to change the name(s) for my child, I will still remain listed as a parent on my child's birth registration, if I am currently listed.

Documentation		Notes	Office Use Only
Other Parent/	Photocopy of other parent/guardian(s') picture ID (e.g. driver's licence) showing their	The address(es) listed on the
Guardian(s)	current address. A copy of a recent utility bill in the name of the other parent/	picture ID of the other parent/
Consenting to	guardian(s) (e.g. BC Hydro bill) is acceptable proof of the current address if it is	guardian(s) must match the
Child's Change	not listed on identification.	residential address provided
of Name	 Photocopy of picture ID is enclosed	above.

This information is collected by the Vital Statistics Agency under section 26(c) of the Freedom of Information and Protection of Privacy Act, and will be used to fulfill the requirements of the Vital Statistics Act for the release of change of name information. Should you have any questions about the collection of this personal information, please contact:

Manager, Vital Statistics Agency, 250 952-2681, PO Box 9657, Stn Prov Govt, Victoria BC V8W 9P3.

Page 8 of 10

VSA 529 2018/0/22

Request to Waive Consent of Other Parent/Guardian(s)

Statutory Declaration

This statutory declaration MUST be completed if the applicant is asking for a waiver of consent of the other parent/guardian(s) unless the other parent/ guardian(s) is(are) deceased. See pages 7 and 10 for further details. Your Statutory Declaration must include ALL of the following information:

If you require more space, attach a separate sheet of paper.

1.Explain in detail all attempts that have been made to gain the consent of the other parent/guardian(s), including contact with relatives, friends, proof of attempted contact or conversation threads regarding the change of name through social media (e.g. Facebook), texting, email threads etc.

2.When was your last contact with the other parent/guardian(s)?

3.What is the last known contact information you have for the other parent/guardian(s)? (Include full addresses, phone numbers, email addresses, or state that all contact information is unknown.)

4.Do you receive child support from the other parent/guardian(s)?

5.Are you registered with the Family Maintenance Enforcement Program (FMEP)? If yes, submit a copy of the most recent statement.

6.Outline any reasons why you feel the change of name is in your child(ren)’s best interest.

7.If the custody/guardianship order submitted with your application is not a final order, state whether or not it is still valid and in effect. As well, include any future court dates.

IMPORTANT - Select one:

I authorize or  I do not authorize the Vital Statistics Agency to use the contact information provided with my application and/or supporting documentation when contacting the other parent/guardian(s) to seek approval for the application.

TO WIT:

I,	of
Applicant's Name	City

in the Province of British Columbia, do solemnly declare that

1.

2.

3.

4.

5.

6.

7.

I verify that all supporting documents represent current circumstances and are in effect as of this date. And I 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 and by virtue of the Canada Evidence Act.

Declared before me at			in the	X
				Declarant’s Signature
Province of British Columbia, this		day of	*	*

Obtaining a Waiver of Parental/Guardian(s) Consent

Under the British Columbia Name Act

The following is a list of grounds on which a waiver of parental/guardian consent may be approved and the documents required. Choose the one that best applies to your situation and provide ALL of the requested information. If information cannot be provided, include a letter of explanation.

A)The other parent/guardian(s) cannot be located after a reasonable, diligent and adequate search has been conducted as demonstrated by the statutory declaration and supporting evidence maintained in the change of name file.

Custody/guardianship order. Obtain an order from the courts prior to applying to legally change the name(s) of your child(ren).

In your statutory declaration list the full mailing address, phone numbers, email addresses and any other contact information for the parent/ guardian(s) whose consent is(are) to be waived.

If you are unaware of the whereabouts of the other parent/guardian(s):

m Include a list of the efforts you have made to determine their location; AND

m Provide proof of attempted contact or conversation thread regarding the change of name through social media (e.g. Facebook), texting, email etc.

In your statutory declaration, you must include ALL of the information listed at the top of page 9, "Statutory Declaration-Request to Waive Consent of Other Parent/Guardian(s)".

If you are registered with the Family Maintenance Enforcement Program (FMEP), include a copy of your latest statement. If you are not registered with FMEP, include a statement indicating that you do or do not receive support from the other parent/guardian(s).

Children 12 years of age or older must write a brief letter in their own words describing why they would like their name to be changed. The letter must be handwritten in ink, and signed and dated by the child.

B)The other parent/guardian(s) is(are) deceased, proven by a copy of a government-issued death certificate maintained in the change of name file.

A copy of a government-issued death certificate of the person whose consent is to be waived.

C)The other parent/guardian(s) is(are) unreasonably withholding their consent.

In your statutory declaration, you must include ALL of the information listed at the top of page 9, "Statutory Declaration-Request to Waive Consent of Other Parent/Guardian(s)".

Provide proof of attempted contact or conversation thread regarding the change of name through social media (e.g. Facebook), texting, email etc.

If you are registered with the Family Maintenance Enforcement Program (FMEP), include a copy of your latest statement. If you are not registered with FMEP, include a statement indicating that you do or do not receive support from the other parent.

Children 12 years of age or older must write a brief letter in their own words describing why they would like their name to be changed. The letter must be handwritten in ink, and signed and dated by the child.

D)The other parent/guardian(s) is(are) mentally disordered, as demonstrated by statutory declaration and supporting evidence

A letter from a physician/court order stating the person whose consent is to be waived is incapable of understanding what they would be signing.

Children 12 years of age or older must write a brief letter in their own words describing why they would like their name to be changed. The letter must be handwritten in ink, and signed and dated by the child.

E)Exceptional circumstances make it unreasonable to seek the consent of the other parent/guardian(s). Unless you can provide a valid court ordered restraining order/no contact order between the other parent/guardian(s) and the child(ren) this option does not apply.

m A court ordered no contact order; OR m A court ordered restraining order; OR

m A letter from the police indicating you would be in danger if you attempted to contact the parent/guardian(s) whose consent is required.

Children 12 years of age or older must write a brief letter in their own words describing why they would like their name to be changed. The letter must be handwritten in ink, and signed and dated by the child.

NOTE: Requirements identified in this information sheet are a guide only and the registrar general of the Vital Statistics Agency has the authority to ask for additional information.

Statements made in a statutory declaration are considered the equivalent of statements made in a Court of Law and may provide the basis for action against the applicant if they are proven to be fraudulent.

This information is collected by the Vital Statistics Agency under section 26(c) of the Freedom of Information and Protection of Privacy Act, and will be used to fulfill the requirements of the Vital Statistics Act for the release of change of name information. Should you have any questions about the collection of this personal information, please contact:

Manager, Vital Statistics Agency, 250 952-2681, PO Box 9657, Stn Prov Govt, Victoria BC V8W 9P3

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VSA 529 2018/0/22