ACCOUNT_FIRST_NAME  ACCOUNT_LAST_NAME

ACCOUNT_ADDRESS_SINGLE_LINE

ACCOUNT_PHONE_NO ACCOUNT_EMAIL

To AUTHORITY, 

ADDRESS

25 November 2024

Dear Sir or Madam, 

Re: Request for Name Change - Ref. no:  

I am writing with the intention to make a formal request for changing my name. The reason for the request is [insert reason].

My current name and address is:

Previous name: [insert name]

Previous address: [insert address]

My new legal name and address is:

Previous name: [insert name]

........................................