June 17, 2019
TO WHOM IT MAY CONCERN
I, ________ ____, the undersigned, South African citizen would like to request that my new South African passport reflects the following surname:
Double-barrelled surname of: __________________________
ID NUMBER: ___________________________________
Maiden surname of: ____________________________________
ID NUMBER: ____________________________________
Married surname of: ___________________________________
ID NUMBER: ___________________________________
Thank you for granting my wish.
Sincerely,
__________________________________
Signature