You do not need to complete the Breakdown of Spousal Relationship Statutory Declaration if you are legally divorced. Use your divorce certificate as proof that you are divorced and want to go back to your former surname.
You can complete the Breakdown of Spousal Relationship Statutory Declaration form if:
- you are separated, but not divorced; or
- your common-law relationship has ended and you wish to use your previous surname.
Process for using your former surname
- Complete and submit the Breakdown of Spousal Relationship Statutory Declaration form.
You can go back to the surname you had at birth or the surname you had just before you took your spouse’s surname.
- Once your form has been processed by the Health Services Administration Office, a certified copy will be provided to you.
You can use the certified copy as proof that you have chosen to go back to your former surname.
To ensure your application is successful, please see the information on eligibility and fees.
Contact this Service
Phone: 1-800-661-0830 (toll free)
Hours: 9:00 AM – 4:30 PM (Monday to Friday, closed statutory holidays)
Sending the Completed Form…
Registrar General of Vital Statistics
Health Services Administration Office
Inuvik, NT X0E 0T0