Home Tuition - Change of Name Form (AF-SNTG17)

• Published date: 23 October 2019
• Issuer: Department of Education

AF-SNTG17 1 Last Updated: 30/10/2018

CHANGE OF NAME REQUEST FORM

The completed claim form should be submitted to:

Home Tuition Payments Section, Schools Division Financial, Department of Education and Skills,

Cornamaddy, Athlone, Co. Westmeath, N37 X 659

Important: This Department can only maintain one name for each individual.

Current details held by this Department.

Name: ____________________________________ PPSN: ________________________________

Date of Birth: __________________________

I, the undersigned, wish to inform the Department of Education & Skills that I have now changed my name to the

following:

Name: __________________________________________________

With effect from: _________________________________________

Reason for name change:

Marriage: Please forward original or certified copy of legal Marriage Certificate

Deed Poll: Please forward original or certified copy of your registered deed poll

Other Reason: Please forward any and all supporting documentation.

Please Specify: ___________________________________________________________

Signature: _________________________________________ Date: ________________

Data Protection Privacy Statement

The Department of Education and Skills, as far as practicable and having regard to the resources available, provides

for education and training for people resident in the State at a level appropriate to meet the needs and abilities of

those people. The main purpose for which the Department requires the personal data provided by you is to affect

your change of name and to support the accounting process the payment of this grant and the accounting and

auditing of public monies. The privacy notice outlining further information in relation to this form can be found at

https://www.education.ie/en/The-Department/Data-Protection/gdpr/ . Full details of the Department's data

protection policy setting out how we will use personal data as well as information regarding your rights as a data

subject are available at https://www.education.ie/en/The-Department/Data-Protection/. Details of this policy and

privacy notice are also available in hard copy from the address above upon request.