Home Tuition - Change of name form (HT6 SEN)

Published date25 October 2019
IssuerDepartment of Education
Rannóg na nÍocaíochtaí Teasgasc Baile Home Tuition Payment Section,
Rannán na Scoileanna- Airgeadas, Schools Division Financial,
An Roinn Oideachais agus Scileanna Department of Education and Skills
Cor na Madadh Cornamaddy
Baile Átha Luain Athlone
Co. na hIarmhí N37X659 Co. Westmeath N37X 659
+353-9064-83600 +353-090648148 www.education.ie
htpayments@education.gov.ie HT6 FORM Sept. 2017
Important: This Department can only maintain one name for each individual.
Current details held by this Department.
Name: ____________________ PPSN: ______________
Date of Birth : _______________________ Teaching Council Registration Number : ____________
I, the undersigned, wish to inform the Department of Education & Skills, that I have now changed my
name from that which is listed above to :
With effect from: _____________________
I confirm that I wholly renounce, relinquish and abandon the use of my old name and in place thereof
assume and adopt from the date listed above my new name so that I may hereafter be called known and
distinguished not by my old name but by my new name.
That I shall at all time hereafter in all records , deeds and documents and any other writing and in all actions,
suits and proceedings as well as in all dealings, transactions matters and things whatsoever and upon all
occasions use and subscribe my new name in place and in lieu of my old name relinquish as aforesaid.
That I expressly authorise and request all persons at all times herafter to designate and address me by my
assumed and adopted new name.
That I have informed and notified the Revenue Commissioners and the Department of Employment Affairs
and Social Protection of my name change and I attach a copy of the notification received from them
confirming the name change,
Old Name Signature : _________________________________________ Date: ________________
New Name Signature : _________________________________________ Date : ________________
Reason for name change :
Marriage : __________________ Please forward your legal Marriage Certificate
Deed Poll : _________________ Please forward copy of your registered deed poll
Other Reason : ________________ Please forward any and all supporting documentation.

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