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 :

J'ai réalisé une démarche administrative

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