Application And Order Form For Birth Certificate (For South Australian Births Only)
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1
2Application and Order form
for Birth Certificate
(for South Australian births only)
Applicant’s details
Full name (mother/father/co-parent/self)
Daytime contact phone number
Residential address
Postcode
Postal address
Postcode
Relationship to child
Signature
Applicant’s identification
Please DO NOT send original identification documents
(for South Australian applications)
If this application form is NOT accompanied by the Birth Registration Statement, attach a copy of the following:
ONE of the following (showing photo and OR TWO of the following (one must show current name and address and one must show signature):
current name, address and signature):
Passport
Department of Veterans’ Affairs card
Current Australian Firearms licence
Business and Occupational Services licence
Current Australian driver’s licence
Centrelink or health care card
Defence force/police service ID card
Proof of age card
Pension/seniors card
Electricity/gas/other utilities account
Credit/direct debit card OR bank statement
Telephone/mobile account
Please contact the Births, Deaths and Marriages Registration Office for additional identification examples if you have none of the above.
Order details
Standard Certificate
$47
Birth certificates are not issued automatically or free of charge.
OR
You may order a Standard Certificate (only) OR
Commemorative Package
$66
Choose from designs over the page (see reverse side)
(including standard certificate)
For (child’s full name)
Code (see over)
Date of birth
Qty
Price $
Amount
/
/
$
$
$
$
Total $
$
Please complete payment details below and post your order to Consumer and Business Services,
Births, Deaths and Marriages, GPO Box 1351, Adelaide SA 5001.
For further information please telephone 131 882 or visit our website at
Payment details
I enclose a cheque/money order, payable to Births,
$
OR
Deaths and Marriages Registration Office, for Amount
Name of cardholder
Amount
$
Signature
Date
/
/
Debit my
Mastercard
Visa
Card number
Expiry date
CVV
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