HOME •  ACTIVE MEMBERS •  RETIREES •  EMPLOYERS •  CONTACT US •  SITE MAP

Acceptable Proof
of Birth and Name Change

Acceptable Proof of Birth
Acceptable Proof of Name Change

Proof of Birth

A photocopy of one of the following:

  1. Birth certification
  2. Baptismal certificate or a statement as to the date of birth shown by a church record, certified by the custodian of such record
  3. Notification of registration of birth in a public registry of vital statistics
  4. Certification or record of age by the U.S. Census Bureau
  5. Hospital birth record, certified by the custodian of such record
  6. Foreign church or government record
  7. Signed statement by the physician or midwife who was in attendance at birth, as to the date of birth shown on their records
  8. Naturalization record
  9. Immigration papers

If you are unable to provide proof according to 1-9 above cannot be provided, submit a photocopy of two of the following documents:

  1. Military record
  2. Passport
  3. School record, certified by the custodian of such record
  4. Vaccination record, certified by the custodian of such record
  5. Insurance policy application that shows the age or date of birth
  6. Marriage records showing date of birth or age (application for marriage license or church record, certified by the custodian of such record or marriage certificate)
  7. Other evidence such as signed statements from persons who have knowledge of the date of birth.

Proof of Name Change

A photocopy of one of the following:

  1. Marriage or other court records showing birth name and present name (If a person has had more than one name change, records submitted must reflect all name changes.)
  2. Name Change Affidavit (KPERS-40NC) or other notarized affidavit from a parent listing all name changes
  3. Request for Member Information Change form (KPERS-12) signed and submitted to KPERS by designated agent at the time of the name change will be acceptable for name changes occurring during employment.

If you are unable to provide proof according to 1-3 above, submit a photocopy of two of the following documents:

  1. Name Change Affidavit (KPERS-40NC) or other notarized affidavit from two persons declaring that the persons have known the applicant by all names in question

  2. Birth documents of natural child if document shows both the given name and the married name

  3. Other documents showing both names in question such as school records, medical records, insurance policy application, etc.