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This consolidation is unofficial and is for reference only. For the official version of the regulations, consult the original documents on file with the Registry of Regulations, or refer to the Royal Gazette Part II. Regulations are amended frequently. Please check the list of Regulations by Act to see if there are any recent amendments to these regulations filed with the Registry that are not yet included in this consolidation. Although every effort has been made to ensure the accuracy of this electronic version, the Registry of Regulations assumes no responsibility for any discrepancies that may have resulted from reformatting. This electronic version is copyright © 2015, Province of Nova Scotia, all rights reserved. It is for your personal use and may not be copied for the purposes of resale in this or any other form.
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 to O.I.C. 2016-96 (March 31, 2015, effective April 1, 2015), N.S. Reg. 77/2015
Section 1 repealed: O.I.C. 2013-105, N.S. Reg. 79/2013.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 $165.70, plus $24.95 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. 2015-96, N.S. Reg. 77/2015.
7 Every application for duplicate certificate of change of name shall be accompanied by a fee of $18.65.
Section 7 replaced: O.I.C. 2000-442, N.S. Reg. 153/2000; amended: O.I.C. 2015-96, N.S. Reg. 77/2015.
Form A repealed: O.I.C. 2013-105, N.S. Reg. 79/2013.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. OFFICE USE
ONLY
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) OFFICE USE
ONLY
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 )
Date ______________________________________ No 3986 D
Issued to ___________________________________
Original No. ________________________________ Fee Collected
________________________________________________________________
[Form E - 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
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