Change of Name Regulations, 1996, C-6.1 Reg 1

1 CHANGE OF NAME C-6.1 REG 1 The Change of Name Regulations, 1996 being Chapter C-6.1 Reg 1 (effective November 15, 1996) as amended by Saskatchewan Regulations 46/2002, 45/2004, 49/2007, 103/2010, 2/2020 and 95/2025. NOTE: This consolidation is not official. Amendments have been incorporated for convenience of reference and the original statutes and regulations should be consulted for all purposes of interpretation and application of the law. In order to preserve the integrity of the original statutes and regulations, errors that may have appeared are reproduced in this consolidation. 2 C-6.1 REG 1 CHANGE OF NAME Table of Contents 1 Title Appendix 2 Interpretation Form C.N. 1 Application for Change of Name 2.1 Change of name registry Form C.N. 2 Registration of Change of Name 3 Fees Form C.N. 3 Certificate of Change of Name 4 Forms Form C.N. 4 Registration of Change of Name Effected 4.1 Residency requirement Outside the Province of Saskatchewan 4.2 Certified criminal record check Form C.N. 5 Certificate of Registration of Change of 5 Exemptions Name Effected Outside the Province of 5.1 Refusal to register a change of name Saskatchewan 6 Form for publishing in the Gazette Form C.N. 6 Application for Duplicate Certificate 7 R.R.S. c.C-6 Reg 1 and R.R.S. c.C-6 Reg 3 repealed Form C.N.7 Application for Alteration of Given Name(s) within Twelve Months from Day of Birth Form C.N.8 Statutory Declaration for Alteration of Name(s) 3 CHANGE OF NAME C-6.1 REG 1 CHAPTER C-6.1 REG 1 The Change of Name Act, 1995 Title 1 These regulations may be cited as The Change of Name Regulations, 1996. Interpretation 2 In these regulations, “Act” means The Change of Name Act, 1995. 26 Jly 96 cC-6.1 Reg 1 s2. Change of name registry 2.1 The change of name registry consists of the following records: (a) changes of name by application or changes of name by election that are registered pursuant to the Act or any former Change of Name Act; (b) forms filed pursuant to the Act or any former Change of Name Act or any former Vital Statistics Act respecting a change of name; (c) changes of name or registrations that are annulled by the director pursuant to the Act or any former Change of Name Act; (d) orders issued by the director pursuant to the Act or any former Change of Name Act for the following purposes: (i) to annul a change of name or a registration made pursuant to the Act or any former Change of Name Act; (ii) to require the return of any certificate or duplicate certificate that has been issued pursuant to the Act or any former Change of Name Act; (e) annual indexes that are maintained by the director pursuant to the Act or any former Change of Name Act; (f) orders issued by a court of competent jurisdiction pursuant to the Act or any former Change of Name Act; (g) notices of motion served on the director pursuant to the Act or any former Change of Name Act; (h) documents accepted by the director as information or documentary evidence pursuant to the Act or any former Change of Name Act that are submitted along with a change of name by application; (i) paper and microfiche indexes of registrations for a change of name completed pursuant to the Act or any former Change of Name Act; (j) microfilm and electronic copies of the records mentioned in clauses (a) to (i). 8 Oct 2010 SR 103/2010 s3. 4 C-6.1 REG 1 CHANGE OF NAME Fees 3(1) The fee payable to the director: (a) for each registration of an application for a change of name, is $125; (b) for each registration of a change of name made pursuant to the laws of another jurisdiction, is $25; (c) for each duplicate certificate issued, is $25; (d) for each certified copy of a notice of surname by a married woman, is $20; (e) for each certified copy of notice of election of a double surname by a married person, is $20; (f) for each certified copy of a joint declaration with respect to a spousal relationship filed pursuant to subsection 20(2) of the Act, is $25; (g) for each certified copy of a declaration with respect to the termination of a spousal relationship filed pursuant to subsection 23(3) of the Act, is $25. (2) In addition to the fee prescribed in clause (1)(a), a person who applies for a change of name shall pay to the director, for publishing in the Gazette the names of persons who are 15 years of age or older at the time of the application and who are listed on the application, a fee in the amount of: (a) $10.70 for the first person 15 years of age or older who is listed on the application; and (b) $3.21 for each additional person 15 years of age or older who is listed on the application. (3) The fee payable to the director for issuing a certified copy or photographic print of any document for which no fee is otherwise prescribed is $50. (4) A person is exempt from paying the fees mentioned in subsections (1) to (3) with respect to an application if: (a) the person’s application is made to alter or add to the given name of a child whose birth has been registered pursuant to The Vital Statistics Act, 2009 or The Vital Statistics Act, 1995 and the application is received by the director within one year after the date of the child’s birth; or (b) the person provides evidence that is satisfactory to the director that: (i) the given name or surname printed on the person’s certificate of birth issued pursuant to The Vital Statistics Act, 2009 or any former Vital Statistics Act is different from the given name or surname recorded on the person’s statement of live birth; and (ii) the person has used the given name or surname recorded on the person’s certificate of birth mentioned in subclause (i) throughout the person’s life. 26 Jly 96 cC-6.1 Reg 1 s3; 14 Jun 2002 SR 46/2002 s2; 25 Jne 2004 SR 45/2004 s3; 22 Jne 2007 SR 49/2007 s3; 8 Oct 2010 SR 103/2010 s4; 12 Dec 2025 SR 95/2025 s3. 5 CHANGE OF NAME C-6.1 REG 1 Forms 4(1) Form C.N. 1 of the Appendix is the prescribed form for the purposes of subsection 6(1) of the Act. (2) Form C.N. 2 of the Appendix is the prescribed form for the registration of a change of name pursuant to subsection 12(1) of the Act. (3) Form C.N. 3 of the Appendix is the prescribed form for a certificate of change of name pursuant to subsection 12(4) of the Act. (4) Form C.N. 4 of the Appendix is the prescribed form for the registration of a change of name effected outside of Saskatchewan for the purposes of subsection15(2) of the Act. (5) Form C.N. 5 of the Appendix is the prescribed form for a certificate of the registration of a change of name effected outside of Saskatchewan for the purposes of subsection 15(3) of the Act. (6) Form C.N. 6 of the Appendix is the prescribed form for an application for a duplicate certificate for the purposes of section 16 of the Act. (7) Form C.N. 7 of the Appendix is the prescribed form for an application pursuant to Part II of the Act made within one year after the date of a child’s birth to alter or add to the given name of a child whose birth has been registered pursuant to The Vital Statistics Act, 2009 or The Vital Statistics Act, 1995. (8) Form C.N. 8 of the Appendix is the prescribed form for an application pursuant to Part II of the Act to amend the given name or surname on a registered statement of live birth to reflect the given name or surname recorded on a certificate of birth issued pursuant to The Vital Statistics Act, 2009 or any former Vital Statistics Act. 26 Jly 96 cC-6.1 Reg 1 s4; 8 Oct 2010 SR 103/2010 s5. Residency requirement 4.1 Unless otherwise exempted by the Act or these regulations, every person for whom a change of name is being requested in an application for a change of name pursuant to the Act must: (a) meet the residency requirements of clauses 5(2)(a), (b) and (c) of the Act; and (b) at the time the application for a change of name is submitted to the director, be a resident as defined in The Saskatchewan Medical Care Insurance Act. 8 Oct 2010 SR 103/2010 s6. Certified criminal record check 4.2(1) In this section, “certified criminal record check” means a fingerprint‑based criminal record check that is provided by one of the following agencies: (a) the Royal Canadian Mounted Police; (b) a police service within the meaning of The Police Act, 1990; 6 C-6.1 REG 1 CHANGE OF NAME (c) an agency acceptable to the director that is accredited by the Royal Canadian Mounted Police to capture fingerprints and submit them for processing to the Royal Canadian Mounted Police’s Canadian Criminal Real Time Identification Services (CCRTIS). (2) Unless the director considers it to be unnecessary, every application for a change of name of a person 18 years of age or older must be accompanied by a certified criminal record check for that person in a form satisfactory to the director. (3) The director may require a person to provide the director with additional documentation from a court of competent jurisdiction respecting any matter mentioned in section 5.1 concerning that person. (4) Notwithstanding section 2.1, certified criminal record checks and any documentation provided pursuant to subsection (3) shall not be included in the change of name registry. 12 Dec 2025 SR 95/2025 s4. Exemptions 5(1) A change of name of any of the following persons is exempt from the requirements of subsection 14(1) of the Act if the Minister of Justice or the director appointed pursuant to The Witness Protection Act has informed the director that it is in the interest of the administration of justice that the change of name not be made public: (a) a person who: (i) has been or will be a witness in a criminal proceeding; or (ii) has provided information to the police in relation to a criminal investigation; (b) a person, other than a person mentioned in clause (a), who has participated in or will participate in a criminal proceeding; or (c) a person who is related to or closely associated with a person mentioned in clause (a) or (b). (2) A person who is under the age of 15 years when the person’s name change is registered pursuant to section 10 of the Act is exempt from the requirements of subsection 14(1) of the Act. (3) For the purposes of subsection 14(1) of the Act, the director is not required to publish a notice of a change of name in the Gazette if, in the opinion of the director: (a) publication of the notice would be contrary to the public interest; or (b) publication of the notice would cause undue hardship for the applicant or any other person who is a subject of the application. (4) If the director receives an application pursuant to Part II of the Act, the applicant is exempt from the residency requirements of clauses 5(2)(a), (b) and (c) of the Act and every person for whom a change of name is being requested is exempt from the residency requirements of section 4.1 of these regulations if: (a) the application is to alter or add to the given name of a child whose birth has been registered pursuant to The Vital Statistics Act, 2009 or The Vital Statistics Act, 1995 and that application has been made within one year after the date of the child’s birth; or 7 CHANGE OF NAME C-6.1 REG 1 (b) the application is submitted by the subject person to alter the person’s registered statement of live birth to reflect the given name or surname recorded on the person’s certificate of birth issued pursuant to The Vital Statistics Act, 2009 or any former Vital Statistics Act. (5) If the director registers a change of name requested in an application that is submitted for one of the reasons mentioned in clause (4)(a) or (b), that change of name is exempt from: (a) the requirement pursuant to subsection 12(4) of the Act to issue a certificate to the applicant setting out the change of name; and (b) the requirement pursuant to subsection 14(1) of the Act to publish in the Gazette a notice of the change of name 26 Jly 96 cC-6.1 Reg 1 s5; 22 Jne 2007 SR 49/2007 s.4; 8 Oct 2010 SR 103/2010 s7; 12 Dec 2025 SR 95/2025 s5. Refusal to register a change of name 5.1(1) For the purposes of clauses 10(2)(b) and 15(1.1)(b) of the Act, the director may refuse to register a change of name if the director considers that the name given: (a) might reasonably be expected to cause: (i) mistake or confusion; or (ii) embarrassment to any other person; (b) is sought for an improper purpose; or (c) is objectionable on other grounds. (2) Without limiting the generality of subsection (1), the director may refuse to register a change of name if the applicant or any other person 18 years of age or older for whom the applicant is requesting the change of name: (a) has been convicted of a designated offence; (b) has been found by a court, at any time: (i) to be a dangerous offender pursuant to section 753 of the Criminal Code; or (ii) to be a long-term offender pursuant to section 753.1 of the Criminal Code; or (c) is a high-risk offender. (3) For the purposes of subsection (2): “designated offence” means: (a) an offence listed in paragraph (a), (b), (c), (d) or (e) of the definition of ‘primary offence’ in subsection 490.011(1) of the Criminal Code; (b) an offence under section 231 of the Criminal Code; (c) an offence under Part X of the Criminal Code; (d) an offence under section 5, 6, 7 or 7.1 of the Controlled Drugs and Substances Act (Canada) with respect to a substance included in Schedule I of that Act; or 8 C-6.1 REG 1 CHANGE OF NAME (e) an attempt or conspiracy to commit an offence mentioned in clause (a), (b), (c) or (d); (« infraction désignée ») “high-risk offender” means: (a) a person with respect to whom a police service has disclosed identifying information after receiving advice with respect to that disclosure from the Public Disclosure Committee in accordance with section 7 of The Public Disclosure Act; or (b) a person: (i) who a police service believes poses a significant risk of serious harm to other persons; and (ii) with respect to whom the police service has, without relying on the application process set out in The Public Disclosure Act, issued a public disclosure, encouraging members of the public to take reasonable steps to ensure their safety; (« délinquant à risque élevé de récidive ») “police service” means the Royal Canadian Mounted Police, a police service as defined in The Police Act, 1990 or any other police service in Canada. (« service de police ») (3.1) In the case of a person described in clause (b) of the definition of “high‑risk offender” in subsection (3), subsection (2) applies only with respect to the period commencing on the day on which the public disclosure of the person’s information is issued and ending on the day on which that public disclosure is rescinded. (4) If, pursuant to this section, the director refuses to register a change of name, the director shall immediately notify the applicant in writing of the director’s decision. 24 Jan 2020 SR 2/2020 s4; 12 Dec 2025 SR 95/2025 s6. Form for publishing in the Gazette 6 The director shall publish the notice required by section 14 of the Act in a form that specifies the name, former name and date of birth of every person whose name is changed as a result of the registration of a change of name. 26 Jly 96 cC-6.1 Reg 1 s6. R.R.S. c.C-6 Reg 1 and R.R.S. c.C-6 Reg 3 repealed 7 The Change of Name Regulations and The Change of Name Exemption Regulations, 1990 are repealed. 26 Jly 96 cC-6.1 Reg 1 s7. 9 CHANGE OF NAME C-6.1 REG 1 10 C-6.1 REG 1 CHANGE OF NAME 11 CHANGE OF NAME C-6.1 REG 1 12 C-6.1 REG 1 CHANGE OF NAME 13 CHANGE OF NAME C-6.1 REG 1 14 C-6.1 REG 1 CHANGE OF NAME 15 CHANGE OF NAME C-6.1 REG 1 12 Dec 2025 SR 95/2025 s7. 16 C-6.1 REG 1 CHANGE OF NAME Form C.N. 2 [Subsection 4(2)] Registration of Change of Name C.N. 2 Registration No. No d'enregistrement Government of Saskatchewan Gouvernement de la Saskatchewan Department of Health Ministère de la Santé Vital Statistics Services de l'état civil The Change of Name Act, 1995 La loi de 1995 sur le changement de nom Registration of Change Enregistrement d'un of Name changement de nom The following changes of name are Les changements de nom ci-après sont registered under the provisions of The Change enregistrés en exécution de la Loi de of Name Act, 1995 of Saskatchewan. 1995 sur le changement de nom de la Saskatchewan. Former Name Ancien nom Address Adresse Date of Birth Date de naissance Name Changed To Nouveau nom Former Name of Spouse Ancien nom du conjoint ou de la conjointe Date of Birth Date de naissance Name Changed To Nouveau nom Name(s) of Child or Children Nom(s) de l'enfant ou des enfants Former Name Name Changed To Date of Birth GIVEN UNDER MY HAND at the City of Regina, in the Province of Saskatchewan, FAIT SOUS MA SIGNATURE dans la ville de Regina, dans la province de la Saskatchewan, this day of ce jour du mois de/d' , 19 . HEALTH / SANTÉ 16-40 / 396 D D I I R R E E C C T T O EU R R O /D F I V RE IT C A T L R S IC T E A T D I E S S T I S C E S RVICES DE L'ÉTAT CIVIL 26 Jly 96 cC-6.1 Reg 1. 17 CHANGE OF NAME C-6.1 REG 1 Form C.N. 3 [Subsection 4(3)] Certificate of Change of Name C.N. 3 Registration No. No d'enregistrement Government of Saskatchewan Gouvernement de la Saskatchewan Department of Health Ministère de la Santé Vital Statistics Services de l'état civil The Change of Name Act, 1995 La loi de 1995 sur le changement de nom Certificate of Change Certificat de changement of Name de nom This is to Certify that on the day of La présente atteste qu'au jour du mois de/d' ,19 the following change(s) of name was (were) registered under the provisions of The Change of Name Act, 1995 le(s) changement(s) de nom suivant(s) a (ont) été consigné(s) en exécution de la Loi de 1995 sur le changement of Saskatchewan. de nom de la Saskatchewan. Former Name Ancien nom Address Adresse Date of Birth Date de naissance Name Changed To Nouveau nom Former Name of Spouse Ancien nom du conjoint ou de la conjointe Date of Birth Date de naissance Name Changed To Nouveau nom Name(s) of Child or Children Nom(s) de l'enfant ou des enfants Former Name Name Changed To Date of Birth Ancien nom Nouveau nom Date de naissance GIVEN UNDER MY HAND at the City of Regina, in the Province of Saskatchewan, FAIT SOUS MA SIGNATURE dans la ville de Regina, dans la province de la Saskatchewan, this day of ce jour du mois de/d' , 19 . DIRECTOR OF VITAL STATISTICS DIRECTEUR/DIRECTRICE DES SERVICES DE L'ÉTAT CIVIL HEALTH / SANTÉ 16-38 / 396 26 Jly 96 cC-6.1 Reg 1. 18 C-6.1 REG 1 CHANGE OF NAME Form C.N. 4 [Subsection 4(4)] Registration of Change of Name Effected outside the Province of Saskatchewan C.N. 4 Registration No. No d'enregistrement Government of Saskatchewan Gouvernement de la Saskatchewan Department of Health Ministère de la Santé Vital Statistics Services de l'état civil The Change of Name Act, 1995 La loi de 1995 sur le changement de nom Registration of Change of Name Enregistrement d'un changement de Effected Outside the Province nom effectué à l'extérieur de la of Saskatchewan province de la Saskatchewan The following changes of name are Les changements de nom ci-après sont registered under the provisions of The enregistrés en exécution de la Loi de 1995 Change of Name Act , 1995 of sur le changement de nom de la Saskatchewan. Saskatchewan. Former Name Ancien nom Address Adresse Date of Birth Date de naissance Name Changed To Nouveau nom Former Name of Spouse Ancien nom du conjoint ou de la conjointe Date of Birth Date de naissance Name Changed To Nouveau nom Name(s) of Child or Children Nom(s) de l'enfant ou des enfants Former Name Name Changed To Date of Birth Ancien nom Nouveau nom Date de naissance GIVEN UNDER MY HAND at the City of Regina, in the Province of Saskatchewan, FAIT SOUS MA SIGNATURE dans la ville de Regina, dans la province de la Saskatchewan, this day of ce jour du mois de/d' , 19 . DIRECTOR OF VITAL STATISTICS HEALTH / SANTÉ 16-41 / 396 DIRECTEUR/DIRECTRICE DES SERVICES DE L'ÉTAT CIVIL 26 Jly 96 cC-6.1 Reg 1. 19 CHANGE OF NAME C-6.1 REG 1 Form C.N. 5 [Subsection 4(5)] Certificate of Registration of Change of Name Effected Outside the Province of Saskatchewan C.N. 5 Registration No. No d'enregistrement Government of Saskatchewan Gouvernement de la Saskatchewan Department of Health Ministère de la Santé Vital Statistics Services de l'état civil The Change of Name Act, 1995 La loi de 1995 sur le changement de nom Certificate of Registration of Certificat d'enregistrement d'un Change of Name Effected changement de nom effectué à Outside the Province of l'extérieur de la province de la Saskatchewan Saskatchewan This is to Certify that on the day of La présente atteste qu'au jour du mois de/d' , 19 the following change(s) of name was (were) registered under the provisions of The Change of Name Act, 1995 le(s) changement(s) de nom suivant(s) a (ont) été consigné(s) en exécution de la Loi de 1995 sur le changement of Saskatchewan. de nom de la Saskatchewan. Former Name Ancien nom Address Adresse Date of Birth Date de naissance Name Changed To Nouveau nom Former Name of Spouse Ancien nom du conjoint ou de la conjointe Date of Birth Date de naissance Name Changed To Nouveau nom Name(s) of Child or Children Nom(s) de l'enfant ou des enfants Former Name Name Changed To Date of Birth Ancien nom Nouveau nom Date de naissance GIVEN UNDER MY HAND at the City of Regina, in the Province of Saskatchewan, FAIT SOUS MA SIGNATURE dans la ville de Regina, dans la province de la Saskatchewan, this day of ce jour du mois de/d' , 19 . DIRECTOR OF VITAL STATISTICS DIRECTEUR/DIRECTRICE DES SERVICES DE L'ÉTAT CIVIL HEALTH / SANTÉ 16-39 / 396 26 Jly 96 cC-6.1 Reg 1. 20 C-6.1 REG 1 CHANGE OF NAME Form C.N. 6 [Subsection 4(6)] Application for Duplicate Certificate 26 Jly 96 cC-6.1 Reg 1. 21 CHANGE OF NAME C-6.1 REG 1 FORM C.N. 7 FORMULAIRE C.N. 7 [Subsection 4(7)] [Paragraphe 4(7)] Application for Alteration of Demande de modification Given Name(s) within Twelve de prénom(s) dans les douze Months from Day of Birth mois suivant la naissance C.N. 7 The Change of Name Act, 1995 Application for Alteration of Given Name(s) within Twelve Months from Day of Birth Loi de 1995 sur le changement de nom Demande de modification de prénom(s) dans les douze mois suivant la naissance In the matter of the birth registered as / Dans l’affaire de la naissance enregistrée sous le nom : _______________________________________________________________________ (Given Name(s) and Surname of Child / Prénom(s) et nom de famille de l’enfant) which took place on the ______ day of __________, ________ at ____________________ qui a eu lieu le ____________________________________ à __________________________ in the Province of Saskatchewan dans la province de la Saskatchewan I/We the below-listed parent(s)/guardians of the child request that the given name(s) recorded on the Statement of Live Birth form of this child be altered to: Je/Nous soussigné(s), parent(s)/tuteur(s) de l’enfant, demande/demandons que les prénoms inscrits dans la déclaration de naissance vivante de l’enfant soient modifiés à : _______________________________________________________________________________ (Enter Given Name(s) Only – Do Not Enter Surname / Inscrivez seulement les prénoms, sans le nom de famille) Parent/Guardian: Parent/Tuteur: _______________________________________________________________________________ Name/Nom _______________________________________________________________________________ Address/Adresse __________________ _________ ____________________ ____________________________ City/Ville Province Postal Code / Code postal Telephone/Téléphone ___________________________________________ _____________________ Signature Date Parent/Guardian: Parent/Tuteur: 22 C-6.1 REG 1 CHANGE OF NAME _______________________________________________________________________________ Name/Nom _______________________________________________________________________________ Address/Adresse __________________ _________ ____________________ ____________________________ City/Ville Province Postal Code / Code postal Telephone/Téléphone ___________________________________________ _____________________ Signature Date If the particulars of more than two (2) parents are recorded on the Statement of Live Birth, the remaining parents are to list themselves over-leaf. Si la Déclaration de naissance vivante contient les données de plus de deux parents, ces autres parents doivent s’inscrire au verso du présent formulaire. Parent/Guardian: Parent/Tuteur: _______________________________________________________________________________ Name/Nom _______________________________________________________________________________ Address/Adresse __________________ _________ ____________________ ____________________________ City/Ville Province Postal Code / Code postal Telephone/Téléphone ___________________________________________ _____________________ Signature Date Parent/Guardian: Parent/Tuteur: _______________________________________________________________________________ Name/Nom _______________________________________________________________________________ Address/Adresse __________________ _________ ____________________ ____________________________ City/Ville Province Postal Code / Code postal Telephone/Téléphone ___________________________________________ _____________________ Signature Date DO NOT WRITE BELOW THIS LINE — OFFICE USE ONLY / NE RIEN ÉCRIRE CI-DESSOUS — À L’USAGE DU BUREAU Notations/Remarques Filed at Regina, Saskatchewan on ________________ ______________________________ Déposé à Regina, en Saskatchewan, le Registrar of Vital Statistics / Registraire des services de l’état civil 23 CHANGE OF NAME C-6.1 REG 1 FORM C.N. 8 FORMULAIRE C.N. 8 [Subsection 4(8)] [Paragraphe 4(8)] Statutory Declaration for Déclaration solennelle Alterationof Name(s) pourmodification de nom(s) C.N. 8 The Change of Name Act, 1995 Statutory Declaration for Alteration of Name(s) Loi de 1995 sur le changement de nom Déclaration solennelle pour modification de nom(s) In the matter of the birth registered as / Dans l’affaire de la naissance enregistrée sous le nom : _______________________________________________________________________ (Given Name(s) and Surname of Child / Prénom(s) et nom de famille de l’enfant) which took place on the ______ day of __________, ________ at ____________________ qui a eu lieu le ____________________________________ à __________________________ in the Province of Saskatchewan dans la province de la Saskatchewan I, Je soussigné(e), _______________________________________________________________________________ (Name of Declarant / Nom du déclarant ou de la déclarante) of in the Province of de ________________________________________ dans la province de _________________ (Full Mailing Address / Adresse postale complète) do solemnly declare that: déclare solennellement ce qui suit : 1. I am the person to whom this birth registration applies. Je suis la personne à qui l’enregistrement de naissance s’applique. 2. The names recorded on the certificate of birth that I previously received from Saskatchewan Vital Statistics are: Les noms inscrits sur le certificat de naissance que j’ai reçu précédemment des Services de l’état civil de la Saskatchewan sont: _______________________________________________________________________________ (Given Name(s) and Surname / Prénom(s) et nom de famille) 24 C-6.1 REG 1 CHANGE OF NAME 3. These names differ from the names recorded on my Statement of Live Birth. Ces noms diffèrent de ceux qui sont inscrits dans ma déclaration de naissance vivante. 4. I have consistently used the names recorded on the certificate of birth believing them to be correct. J’ai fait un usage constant des noms inscrits sur le certificat de naissance, les croyant exacts. 5. I now request that the names recorded on my Statement of Live Birth be amended to correspond to the names recorded on my certificate of birth. Je demande maintenant que les noms inscrits dans ma déclaration de naissance vivante soient modifiés pour correspondre aux noms inscrits sur mon certificat de naissance. And, I make this solemn declaration conscientiously believing it to be true and knowing it to be of the same force and effect as if made under oath, and by virtue of the Canada Evidence Act. Et je fais cette déclaration solennelle la croyant, en mon âme et conscience, véridique et sachant qu’elle a la même force et les mêmes effets que si elle avait été faite sous serment, et en vertu de la Loi sur la preuve au Canada. Declared before me at Déclaré devant moi à _______________________ in the Province of __________________________ ___________________________________ dans la province de Signature of Declarant /Signature du déclarant / de la déclarante this day of ce ____________ _____________________ 20 ______ Signature of Notary Public, Justice of the Peace or Commissioner for Oaths in and for Saskatchewan. Signature du notaire, juge de paix ou commissaire à l’assermentation en et pour la Saskatchewan. My appointment expires _________________________________ Mon mandat expire le ________________________ DO NOT WRITE BELOW THIS LINE — OFFICE USE ONLY / NE RIEN ÉCRIRE CI-DESSOUS — À L’USAGE DU BUREAU Notations/Remarques Filed at Regina, Saskatchewan on ________________ ______________________________ Déposé à Regina, en Saskatchewan, le Registrar of Vital Statistics / Registraire des services de l’état civil 8 Oct 2010 SR 103/2010 s9. REGINA, SASKATCHEWAN PrINTEd by THE AuTHorITy of THE KING’S PrINTEr Copyright©2025