Canadian Legal Resource Centre Inc.
Name Change Digital Background Questionnaire
What will be your NEW name?
First Name
Middle Name
Last Name
What is your OLD / CURRENT legal name?
Ensure this name exactly matches your Government issued Identification
First Name
Middle Name
Last Name
Other Names (Alias)
Note: An alias is only relevant if it has appeared on any legal documentation.
Do You Have Any Aliases?
No
Yes
Alias #1 First Name
Alias #1 Middle Name
Alias #1 Last Name
Alias #2 First Name
Alias #2 Middle Name
Alias #2 Last Name
Personal Details
Date of Birth
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Height in CM
or Ft'In"
Weight in KG
or Lbs
Gender
Male
Female
Unknown
Contact Information
Phone Number
Email Address
Your Current Address
Suite or Apartment Number
Address
City
Province/State
Country
Postal/Zip Code
Miscellaneous Information
Reason for Fingerprinting?
ADOPTION (CDN/INTERNATIONAL)
CANADIAN CITIZENSHIP
EMPLOYMENT (FEDERAL GOVT)
EMPLOYMENT (OTHER)
EMPLOYMENT (POLICE)
EMPLOYMENT (PRIVATE INDUSTRY)
EMPLOYMENT (PROVINCIAL GOVT)
NAME CHANGE
OTHER (SPECIFY REASON)
PERMANENT RESIDENT STATUS
PRIVACY ACT REQUEST 9CMP-PPU-030
RECORD SUSPENSION APPLICATION
VISA / BORDER CROSSING/FOREIGN TRAVEL / WORK
VOLUNTEER EMPLOYMENT
Specify Other Reason
How did you hear about us?
Federal Employment
ORI
Results
Where do you want the RCMP to mail the results?
To a Government Agency
To me at my mailing address above
To Canadian Legal Resource Centre Inc
To a Third Party as indicated below
Name of Third Party
Suite or Apartment Number
Address
City
Province/State
Country
Postal/Zip Code