Application For A Birth Certificate - Nsw Registry Of Births Deaths & Marriages
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1
2Application for a Birth Certificate
NSW Registry of Births Deaths & Marriages ABN 30 854 211 521 GPO Box 30 Sydney NSW 2001 Tel: 1300 655 236
Commemorative Certificate Package (
Urgent
Non-urgent
Includes a standard certificate. Specify design e.g. Gum Blossom: 2)
Harbour (Qty) _____
Booties (Qty) _____
Handprint:
Blue (Qty) _____
Pink (Qty) _____
Gum Blossom (Qty) _____
Nursery (Qty) _____
Feet:
with parents details (Qty) _____
no parents details (Qty) _____
Standard Certificate
(Qty) ________
Urgent
Non-urgent
International Express Post
Your certificate will be mailed to you if your application was received by post or fax and is charged a postage and handling fee. See separate “Fees for Products and Services” Flyer.
Please PRINT clearly in BLACK pen. Start at the left. Write one letter in each box. Leave one box between words. Please complete all details.
APPLICANT’S DETAILS (details of person completing this form).
Please provide at least three (3) copies of identification with your application.
Family Name
Given Names
Street Address
Suburb
State
Postcode
Postal Address (if different
from street address)
Suburb
State
Postcode
Your Relationship to the Person
Registered
(e.g. self, daughter)
Reason Certificate is Required
(e.g. passport, school)
Home Phone Number (
)
Signature of Applicant
Contact Phone Number (
)
DETAILS OF BIRTH REQUIRED
Family Name
at Birth
Given Names
Date of Birth*
Present Age
/
/
* If Date Unknown,
Period to be Searched - From
To
(Note, each extra 10 year search or part thereof incurs a cost)
Place of Birth
(Town/City)
State
Father’s Full Name
Mother’s Full Name
(Before Marriage)
PAYMENT DETAILS (complete this section for mail or fax applications only).
For schedule of fees, see Fees for Product and Services flyer.
OR Please Debit my:
Enclosed is a Cheque*/
(Cheques should be made
Money Order for
$
•
AMEX
MasterCard
Visa
$
•
payable to the ‘NSW Registry
of Births Deaths & Marriages’)
Card Number
Name of Cardholder
Expiry Date
/
Signature of
Cardholder
*Personal/company cheques are not accepted for urgent applications.
OFFICE USE ONLY
Identification
Date Issued
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