Electoral Services Change of Name Request

Fields marked with * are required
Your details
1. Your Full Name:*
2. Do you have an email?*
  
  Yes
  
  No
3. Your Email:
4. Your Telephone Number:*
5. Please enter your postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
  
  If your address is not shown please enter the address manually.
6. Your Postcode:
8. Address Box
9. First line of your address:*
10. Address 2:
11. Town:*
12. Postcode:*
13. What was your previous full name?*
14. Please note: Uploading the evidence required will mean your change can be processed faster
15. Are you able to upload evidence of name change?:*
  
  Yes
  
  No
  See below for documents accepted and please upload them if possible
16. Please note: Not providing evidence may mean your change can not be actioned
17. Please post a photocopy of your evidence to our Dereham office ASAP:
  
  F.A.O. Elections team,
  
  Breckland Council,
  
  Elizabeth House,
  
  Walpole Loke,
  
  Dereham
  
  Norfolk, NR19 1EE
18. Evidence
  1. Name Change Documentation
    Documents accepted: Marriage or Civil Partnership Certificate, Overseas Marriage or Civil Partnership Certificate, Amended Birth Certificate or Deed Poll. Permitted file type: JPEG, PNG, PDF. Maximum file size: 5MB
19. Are you completing this form on behalf of someone else?:*
  
  Yes
  
  No
20. Assisted service details
  1. In what capacity are you completing this form?:
    
    CC Staff
    
    Agent/Solicitor
    
    Relative/Friend
    
    Carer
    
    Other
  2. Name of person completing this online form:
  3. Email of person completing this form:
Privacy statement

Breckland Council is collecting this information, via this form, in order to perform this service or function, and if further information is needed in order to do so, you may be contacted using the details provided.

In performing this service, the Council may share your information with other organisations or departments, but only when it is satisfied that it is necessary to perform a public task, or to exercise its statutory duties to do so.

The Council may also share your personal information for the purposes of the prevention, investigation, detection, or prosecution of criminal offences, but will not share your personal information, or use it for any other purpose, unless provided for by law.

More detailed information about the Council's handling of your personal data can be found in our privacy policy.
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Electoral Services Change of Name Request

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Electoral Services Change of Name Request

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