[Your home address]
[Your daytime telephone number]
To whom it may concern.
I, the undersigned, having parental responsibility for [insert child’s current full name here] consent to [his/her] name being changed to [insert new full name here].
I am unable to obtain the father’s consent because for the last four years I have not known his whereabouts. I have written to the father’s last known address but I have not had a reply. I have also contacted several relatives but they do not know his whereabouts either. The Child Support Agency have also been unable to locate him.
Since the father left us in July 2009, he has had very little contact with us. I understand he moved away from the area in 2011 and since then we have had no contact whatsoever. He pays no maintenance and does not even send his child birthday or Christmas cards.
My child is now old enough to understand the situation and is very distressed at having to use the name of someone who has, for many years, shown no interest in [him/her] whatsoever.
Note: This last paragraph is only suitable if your child is old enough to understand the situation (age 6 or 7 upwards) and is upset with having to use the father’s surname.
[Your full name] Mother
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