Affidavit for Name Change in Passport

I. Personal Information

I, the undersigned individual, hereby declare the following details for the purpose of executing a name change on my passport. Below are my current personal details:

A. Current Personal Details

• Full Legal Name: Jewell Ward

• Date of Birth: November 8, 2050

• Place of Birth: Houston, TX 77001

• Current Residential Address: Houston, TX 77001

• Current Passport Number: TX 700021

• Nationality: American

II. Details of Change

A. Proposed New Name

• First Name: Jewel

• Last Name: Ward

B. Reason for Name Change

Personal preference

III. Supporting Documents

To support my request for a name change in the passport, I have attached or will provide the following documents:

• Original or certified copy of the name change certificate or deed poll.

• Updated identification documents reflecting the new name, if available.

• Proof of marital status (e.g., marriage certificate, divorce decree), if applicable.

• Any other relevant documents: [Specify any additional documents provided]

IV. Declaration

I hereby declare under penalty of perjury that all information contained in this affidavit is true and correct to the best of my knowledge, and I undertake to notify the passport authority of any changes to the information provided herein.

Signature

Jewell Ward

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