Application for Commemorative Or Legal Birth Certificate

The commemorative certificates cannot be used for official purposes. Commemorative certificates are A3 paper size only and legal certificates are A4 paper size only. Identification must be produced by the applicant; this can include any one of the following:

Passport, Driver licence, Evidence of age card, Ochre card

Otherwise any 2 forms of the following:

Medicare card, Key card, credit card, current bank statements, student identity card, citizenship papers, tax file number, letter from Council/Community Certificate collection Certificates can be collected from the Darwin or Alice Springs offices from Monday to Friday 8.00am - 4.00pm, or the Palmerston Office Friday mornings only between 8:00am to 12:00 noon. Otherwise certificates can be posted for a fee.

Darwin office Palmerston office Alice Springs office Ground Floor, Nichols Place Zone Community Care Centre Centrepoint Building, corner B, corner Bennett and Cavenagh Palmerston Health Precinct on Gregory and Hartley Street, Alice Streets, Darwin Gurd Street Springs Phone: (08) 8951 5339 Phone: (08) 8999 6119 Friday Morning Only Fax: (08) 8999 6324 8:00am to 12:00 noon Fax: (08) 8951 5340

Commemorative certificate options

Wildlife Indigenous Scenery Abstract

Blue bunny Ducks Pink bunny Clowns

Department of Attorney-General and Justice Page 1 of 2 Application for commemorative or legal birth certificate Certificate collection or postage Darwin Palmerston Alice Springs Please post for $12.30

Certificate package Certificate options Commemorative and legal certificate Commemorative Certificate Legal certificate Type of package quantity $65.00 $40.00 each $44.00 each

Commemorative certificate theme options Please indicate type of certificate and how many are required by placing the quantity in numbers. Please also indicate whether you would like the certificate laminated at $3.30 each for legal certificate or $6.05 each for commemorative certificates by ticking the box.

Certificate Legal Blue Bunny Duck Clown Indigenous Wildlife Pink Bunny Scenery Abstract Total Quantity $

Laminated $

Details and payment If using credit card payment the form can be faxed but must be accompanied by a certified photocopy of identification. Cheques and money orders can be made payable to Receiver of Territory Monies and posted to GPO Box 3021, Darwin NT 0801or PO Box 8043, Alice Springs NT 0871.

Child’s surname: Child’s given name in full: Child’s birth details: Date (DD/MM/YYYY): / / Place of birth: Child’s father’s full name(s): Child’s Mother’s full name(s): Child’s Mother’s maiden surname: Applicant name: Applicant address: Applicant phone: Applicant’s relationship to person registered: Reason for which certificate is required: Signature of applicant: Total cost: Cheque Money order Payment details: Credit card type: Bankcard Mastercard Visa

Credit card details Expiry (MM/YY): / Card number: Signature of card holder: Name on card in block letters: Office use only Application No: Registration No: Certificate No: I.D sighted: Date posted: On collection for clients Date received: Receiver signature:

Department of the Attorney-General and Justice Page 2 of 2