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Change of Name Regulations

made under Section 21 of the

Change of Name Act

R.S.N.S. 1989, c. 66

O.I.C. 77-942 (August 2, 1977), N.S. Reg. 74/77

as amended up to O.I.C. 2013-105 (March 28, 2013, effective April 1, 2013), N.S. Reg. 79/2013

 

[Please note: Effective January 30, 2014, these regulations are amended by N.S. Reg. 18/2014 (O.I.C. 2014-31)]


Section 1 repealed: O.I.C. 2013-105, N.S. Reg. 79/2013.

 

2     An application for a change of name shall be in Form B.

 

3     A consent to a change of name shall be in Form C.

 

4     A statutory declaration as to the bona fides of an application for a change of name shall be in Form D.

 

5     A certificate of change of name shall be in Form E.

 

6     Every application for a change of name shall be accompanied by a fee of $160.85, plus $24.20 for each additional request for a consequential change to a birth or marriage record that is included with the application.

Section 6 replaced: O.I.C. 2000-442, N.S. Reg. 153/2000; amended: O.I.C. 2013-105, N.S. Reg. 79/2013.

 

7     Every application for duplicate certificate of change of name shall be accompanied by a fee of $18.10.

Section 7 replaced: O.I.C. 2000-442, N.S. Reg. 153/2000; amended: O.I.C. 2013-105, N.S. Reg. 79/2013.


Form A repealed: O.I.C. 2013-105, N.S. Reg. 79/2013.




Form B - Application for a Change of Name

Province of Nova Scotia

Change of Name Act

 

 

To the Registrar General, Provincial Building, Halifax, Nova Scotia.

 

Note: Birth certificates requested for those born outside of Nova Scotia.

Particulars of Applicant: (required when changing own name, or when applying on behalf of minor children) 

                                                 

1.       Full name as stated on official birth registration:                                     

_____________________________________________________________

                              all given names surname                                

          Name presently known as:                                                                          

2.       Date of birth ____________________     3. Sex ________________      

                                       month day year                                                                           

4.       Place of birth                                                                                               

                                      city or place                 province or country                            

5.       Marital status                             6.   Occupation                                         

7.       Resident in Nova Scotia continuously since                                               

                                                                                month year                 

8.       All places of residence during the last two years:                                       

          Street address, locality, province or country       Dates of residence                          

                                                                             From                    To                       

 

                                  (attach supplementary list if necessary)                                                   

9.       Name of Applicant's Father                                                                      

                                                                            (all given names)                              (surname)               

10.     Maiden name of Applicant's Mother                                                        

                                                                            (all given names)            (surname)                

11.     Is Applicant's name to be changed  Yes _____               No _____           

          If Yes, Applicant's name to be changed to:                                               

          (all given names)                                                                                                           (surname)        

 

(SEE NEXT PAGE REGARDING MINOR CHILDREN)                                              

PARTICULARS OF SPOUSE: (required when   Marriage certificate must be submitted for

married person applying for change of name)         all persons married outside of Nova Scotia

Name of spouse:                                                                                                    

12.                                                                                                                          

                               (all given names)                                                                           (surname)               

13.     Known as                                                                                                    

14.     Address                                                                                                       

15.     Date of birth                                                                                                

                                           month                         day                                           year                              

16.     Place of birth                                                                                               

                                                 city or place                         province or country                                    

17.     Date of marriage                                                                                          

                                           month                         day                                           year                      

18.     Place of marriage                                                                                        

                                           city or place                         province or country                                 

19.     Spouse's name to be changed to                                                                  

                                                             all given names                                 surname                  

PARTICULARS OF CHILDREN                Names of all unmarried minor children must       

(required when application                  be listed hereunder. Submit birth                    

affects child's given or surname)         certificates for those not born in Nova Scotia   

20. (a)   Full name of child                                                                                    

                                                    all given names                                                   surname                  

             Date of birth                                                                                             

                                           month                     day                                                year                     

             Place of birth                                                                                            

                                           city or place                                                                 province or country      

             Proposed name of child in full                                                                 

                                                                all given names                            surname                 

      (b)  Full name of child                                                                                    

                                                 all given names                                                   surname                  

             Date of birth                                                                                             

                                           month                                  day                                  year                      

             Place of birth                                                                                            

                                           city or place                                                                 province or country      

             Proposed name of child in full                                                                 

                                                                 all given names                              surname                 

      (c)   Full name of child                                                                                    

                                                    all given names                                                   surname                  

             Date of birth                                                                                             

                                           month                                  day                                  year                 

             Place of birth                                                                                            

                                           city or place                                                                 province or country      

             Proposed name of child in full                                                                 

                                                                all given names                           surname                  

(Attach supplementary list covering additional children if necessary)


 

Form C - Consent to Change of Name

Province of Nova Scotia

Change of Name Act



To the Registrar General, Provincial Building, Halifax, Nova Scotia;

 

I,                                                                                                                                               

             all given names                                                              surname

 

the legal                                                                                                                                    

wife/mother/father/husband

 

of                                                                                                                                              

             all given names                                                              surname


hereby give my consent

 

      (a)   to the proposed change of my name

 

             from                                                                                                                            

                               all given names                                            surname

 

             to                                                                                                                               

                               all given names                                            surname

and/or

 

      (b)  to the proposed change of my                                                             name

husband's/wife's/child's

 

             from                                                                                                                            

                               all given names                                            surname

 

             to                                                                                                                                

                               all given names                                            surname


Signature of witness:

 


 

 

Address                                                                              Signature

 

                                                                         Date                                              

Month Day Year

 



Form D - Statutory Declaration

Province of Nova Scotia




IN THE MATTER of the Change of Name Act, Chapter 66, Revised Statutes of Nova Scotia, 1989

 

I,                                                                                                                                               

(name in full)

of _________________________, in                                                                                      

(name of city or place)


in the Province of Nova Scotia, DO SOLEMNLY DECLARE:

 

1        That I am the applicant named in the above application.

 

2        That I have read the said application and to the best of my knowledge, information, and believe [belief] the statements therein made are true in substance and in fact.



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 the             )

of                                              , in the       )

Province of Nova Scotia, this                    )

day of                                 , 19                 )

)

)               ______________________________

_____________________________         )                   (Signature of Applicant)

A Barrister, Notary Public, or Commissioner        )


 


[Form E - Certificate of Change of Name]

Date ______________________________________                                                             No 3986              D

Issued to ___________________________________

Original No. ________________________________                                                            Fee Collected

---------------------------------------------------------------------------------------------------------------------

Certificate of Change of Name

No. 3986D

Nova Scotia

Canada




This is to certify that on the _____ day of _______________, 19_____ at the hour of _____________ in the _______________noon, the following change(s) was/were made under the provisions of the Change of Name Act:

 

 

 

 

  

 

 

In witness whereof I have hereunto set my hand at the City of Halifax in the Province of Nova Scotia this ____ day of ____________ , 19_____.

__________________________________

Registrar-General

 

Halifax, __________________, 19__


I CERTIFY that the above is a true and correct copy of the Certificate of Change of Name on file in “The Change of Name Register” in custody of the Registrar-General of the Province of Nova Scotia.


 

 

Clerk                                                                               Deputy Registrar-General