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[Your home address]
[Your daytime telephone number]
[Date]
To whom it may concern.
Dear Sirs,
I, the undersigned, having sole parental responsibility
for [insert child's current full name
here] consent to [his/her]
name being changed to [insert new full
name here].
Now choose ONE of the
following nine paragraphs:
1. If your child's birth was
registered in ENGLAND or WALES
from 1st December 2003, use this paragraph:

I confirm I was not married to my child's father at birth
or subsequently and no other person has acquired parental responsibility
by agreement or by court order. I also confirm the father is not
recorded on my child's birth certificate.

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Click on the Open button if you see a File Download window.
2. If your child's birth was
registered in ENGLAND or WALES
before 1st December 2003, use this paragraph:

I confirm I was not married to my child's father at birth or subsequently
and no other person has acquired parental responsibility by agreement or by
court order.

Click on the icon to download an interactive Word document for this letter.
Click on the Open button if you see a File Download window.
3. If your child's birth was
registered in SCOTLAND
from 4th May 2006, use this paragraph:

I confirm I was not married to my child's father at the
time of conception or subsequently and no other person has acquired parental responsibility
by agreement or by court order. I also confirm the father is not
recorded on my child's birth certificate.

Click on the icon to download an interactive Word document for this letter.
Click on the Open button if you see a File Download window.
4. If your child's birth was
registered in SCOTLAND
before 4th May 2006, use this paragraph:

I confirm I was not married to my child's father at the
time of conception or subsequently and no other person has acquired
parental responsibility by agreement or by court order.

Click on the icon to download an interactive Word document for this letter.
Click on the Open button if you see a File Download window.
5. If your child's birth was
registered in NORTHERN IRELAND
from 15th April 2002, use this paragraph:

I confirm I was not married to my child's father at birth
or subsequently and no other person has acquired parental responsibility by agreement or by court
order. I also confirm the father is not recorded on my child's birth certificate.

Click on the icon to download an interactive Word document for this letter.
Click on the Open button if you see a File Download window.
6. If your child's birth was
registered in NORTHERN IRELAND
before 15th April 2002, use this paragraph:

I confirm I was not married to my child's father at birth
or subsequently and no other person has acquired parental responsibility by agreement or by
court order.

Click on the icon to download an interactive Word document for this letter.
Click on the Open button if you see a File Download window.
7. If your child's birth was
registered in the ISLE OF MAN,
use this paragraph:

I confirm I was not married to my child's father at
birth or subsequently and no other person has acquired parental responsibility
by agreement or by court order.
8. If your child's birth was
registered in the BAILIWICK OF JERSEY,
use this paragraph:

I confirm I was not married to my child's father at birth
and no other person has acquired parental responsibility by agreement or by
court order.
9. If your child's birth was
registered in the BAILIWICK OF GUERNSEY,
use this paragraph:

I confirm I was not married to my child's father at
birth or subsequently and no other person has acquired parental responsibility
by agreement or by court order.
Yours faithfully,
[Mother's signature]
[Mother's full name]
Mother
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