KNOW ALL MEN BY THESE PRESENTS (which are intended to be enrolled at the Central Office of the High Court of Justice in Northern Ireland) made this 25th day of November 20042 that I the undersigned Caroline Niblock of 14 Maryville Walk, Banbridge in the County of Down, unmarried woman, unemployed the legal guardian of Sirena Ellen Niblock born on the 20th November 2001 now or lately called Sirena Ellen Clarke a Commonwealth Citizen on behalf of the said Sirena Ellen Niblock.

WITNESS AND IT IS HEREBY DECLARED AS FOLLOWS:

On behalf of Sirena Ellen Niblock I absolutely and entirely renounce relinquish and abandon the use of her former surname of Sirena Ellen Clarke and on her behalf assume adopt and determine to take and use the surname of Niblock in substitution for her former surname of Clarke. That the said Caroline Niblock shall at all times hereafter in all records, deeds, documents, and other writings and in all actions and proceedings as well as in all dealings and transactions and on all occasions whatsoever use and subscribe the said name of Niblock as my surname in substitution for my former surname of Clarke so relinquished as aforesaid to the intent that she may hereafter be called, known, or distinguished not by the former surname of Clarke but by the surname of Niblock only.

I hereby on behalf of the said Sirena Ellen Clarke authorise and require all persons at all times to designate describe and address her, by the adopted surname of Niblock

Signed, Sealed, Delivered, by the said Caroline Niblock

in the presence of:

Signed (1st witness), Emmet J Kelly, Solicitor, Banbridge

Signed (2nd Witness), Elizabeth Hobson, Secretary, Banbridge