Applying for a birth certificate Online A standard birth certificate is an official certified copy of the You can complete this online at www.nsw.gov.au/bdm Birth Certificate registration data held by the Registry, and is commonly used to help establish a person’s identity. Lodging by post Application This application form is for a birth that occurred in, or was registered in GPO Box 30 YOU CAN NSW. If you are the person named on the certificate, or a parent of the SYDNEY NSW 2001 COMPLETE THIS person named on the certificate, the birth certificate can be issued to you. APPLICATION Lodging in person ONLINE AT: If you DO meet the above criteria, you must provide: Service NSW service centres nsw.gov.au/bdm • Three types of your own ID (see below). service.nsw.gov.au If you DON’T meet the above criteria, you must provide: • A “ Letter of Authority giving permission to apply” available Phone: 13 77 88 • Monday to Friday (7am-7pm) on our website: www.nsw.gov.au/bdm • T hree types of ID from the person giving permission (see below). Amit Citizen Date of Birth: Hearing/Speech impaired, phone: 16 March 2018 Place of Birth: • T hree types of your own ID (see below). Sex: Armidale • TTY 133 677 My Parents Male

Given Name s ( ): Dawn My Parents • NRS 1300 555 727 Surname: Your Right to Privacy Citizen Given Name Place of Birth: s ( ): David Chippendale, NSW Surname: Citizen Place of Birth: When you apply, you consent to the release of information provided, Chippendale, NSW Translating and Interpreting, phone: to those agencies who may be able to validate it. I hereby certify that this is a true copy of particulars • TIS National 131 450 in a Register in the State of New South , in the Date of issue: Commonwealth of Australia. Please read Your Right to Privacy Policy at www.nsw.gov.au/bdm 21 March 2018

Identification (ID) Send information to a office Please provide at least three types of ID, one of each from categories Select this option to send your certificate if you have made

1, 2 and 3. If you are unable to provide ID from categories 1 and 2, Issued by the Registry of Births Deaths and Marriages, New South Wales, Australia. prior arrangements with the Australian office, consulate This Commerative certificate does not contain security features and organisations you must still provide at least three types of ID. At least two of these or embassy. This only applies to standard certificates, not may not accept it as a proof of . must be from category 3. All documents except foreign passports commemoratives. Fee applies, see www.nsw.gov.au/bdm must be current. Commemorative birth certificates Category 1 Category 3 Did you know? You can buy a Commemorative on its own, and it

If born in Australia: • Medicare card makes an ideal gift perfect for framing! Jennifer EdwinaMEMBER NO. 614511 Lenna – JOINED 1995 Citizen

01 December 2015 • An Australian birth certificate • Credit or debit card Commemorative certificates do not contain security features and Siesta Private Hospital, Croydon Park Date of Birth BIRTH CERTIFICATE Place of birth: Parents: Record of immigration • Centrelink or Department of Judith Amber Rose Female Clifford Wade Sex organisations may not accept them as proof of identity documents. Given Names Done New Lambton Heights Citizen Place of Birth Given names: Surname Jonathan Robert Smith Wolverhampton, Staffordshire, status: Veterans Affairs card 29 June 2015 Surname: Blacktown Male Place of Birth Alex Lee Date of birth: Place of birth: Given Names I hereby certify that this is a true copy Citizen • Security guard/Crowd control Sex: of particulars recorded in the Register • Citizenship certificate Surname Lillian Maureen in the State of New South Wales, in the PARENTS Date of Issue: Date of Issue New Lambton Heights Done Commonwealth of Australia. Place of Birth Given names: I hereby certify that this is a true copy of particulars licence Salisbury, Wiltshire, England in the Register in the State of New South Wales, • New Zealand citizenship Birth Certificate Surname: in the Commonwealth of Australia. Hazel Nicola Lewis Place of birth: 05 April 2016 29 June 2015 Date of Birth Sydney, NSW Female Place of birth: Registry of Births Deaths & Marriages NSW • Tertiary education institution Female certificate Sarah Name Wilson Sex: Parents: St George Private Hospital, Kogarah Hunter Wren Citizen 29 June 2017 Place of Birth Date of birth: Sonia Anna 16 March 2018 Date of issue: Female Tom Given Names Date of Birth: Sex: Given names: Wilson Lewis Luke Steven Surname: Surname Given Names Armidale Sydney, NSW My Parents Issued by the Registry of Births Deaths & Marriages, New South Wales, Australia. PARENTS Place of birth: Lewis Place of Birth: Samantha Blacktown, NSW s : David Given names: Place of Birth Surname ( ) This Commemorative certificate does not contain security features and organisations O’Brian Given Name Surname: Blacktown, NSW My Parents ID card Citizen MEMBER NO. 614511 – JOINED 1995 may not accept it as a proof of identity document. Sydney, NSW Place of Birth • New Zealand birth certificate Place of birth: (s): Dawn Surname: Given Name Chippendale, NSW Jennifer Edwina Lenna Citizen I hereby certify that this is a true copy or particulars recorded in a Citizen Place of Birth: Register in the State of New South Wales, in the Commonwealth of Australia. Surname: I hereby certify that this is a true copy or particulars recorded in a Register in the State of New South Wales, in the Commonwealth of Australia. Chippendale, NSW Place of Birth: 01 December 2015 Date of issue: 3 August 2017 Date of Birth Issued by the Registry of Births Deaths and Marriages, Registry of Births Deaths and Marriages NSW New South Wales, Australia.This Commemorative certificate Female does not contain security features and organisations may I hereby certify that this is a true copy of particulars Sex NSW Registry of Births Deaths & Marriages not accept it as proof or identity document. in a Register in the State of New South Wales, in the Parents: Date of issue: 3 August 2017 Commonwealth of Australia. Judith Amber Rose New Lambton Heights Place of Birth Issued by the Registry of Births Deaths and Marriages, New South Wales, Australia. Registry of Births Deaths and Marriages NSW Given Names This Commemorative certificate does not contain security features and organisations may not accept it as proof or identity document. Citizen Surname Alex Lee Blacktown Given Names Place of Birth Citizen 21 March 2018 Surname Date of issue: New Lambton Heights Place of Birth Date of Issue: Date of Issue Issued by the Registry of Births Deaths & Marriages, New South Wales, Australia. This Commemorative certificate does not contain security features and organisations may not accept it as a proof of identity document. I hereby certify that this is a true copy of particulars in the Register in the State of New South Wales, Category 2 Category 4 in the Commonwealth of Australia.

Registry of Births Deaths & Marriages NSW

The Registry does not warrant the accuracy of information relating to club membership details. • Australian driver’s licence • Recent utility account with Issued by the Registry of Births Deaths and Marriages, New South Wales, Australia. Issued by the Registry of Births Deaths & Marriages, New South Wales, Australia. This Commemorative certificate does not contain security features and organisations may not accept it as a proof of identity document. This Commerativemay certificate not accept does it as not a proofcontain of identitysecurity document.features and organisations • current residential address The Registry does not warrant the accuracy of information relating to club membership details. • Firearms licence (issued within last three C ele ing 10br 0at months) er Wren Citien unt YEARS • Foreign passport 1918- 2018 Date of birth: 1 uly 201 Place of birth: Armidale Sex: emale Snugglepot & Cuddlepie

Parents Date of birth: November 1918 Hunter Wren Citizen Place of birth: Given names: Dawn Neutral Bay, NSW Sex: Surname: Citien Two little boys Place of birth: Chippendale, NSW • Proof of age card Date of Birth: 1 July 2016 Parent Hunter Wren Citizen Place of Birth: Armidale Given names: Sex: Female Given names: Dawn Cecilia May Surname: Surname: Citien Gibbs Place of birth: Armidale Parents Date of birth: 1 July 2016 Place of birth: Chippendale, NSW Place of birth: Sydenham, Kent, England Given Name(s): Dawn Sex: Female Given Name(s): Surname: Citizen David I hereby certify that this is a true copy of particulars I hereby certify that this is a true copy of particulars recorded in a Register in the Surname: outh Wales, Parents Place of Birth: Chippendale, NSW Citizen recorded in a Register in the State of New S State of New South Wales, in the Commonwealth of Australia. Given names: Dawn Given names: Dawn Place of Birth: Chippendale, NSW in the Commonwealth of Australia. Surname: Citizen Surname: Citizen Place of birth: Chippendale, NSW If your name has changed you may be asked to show proof Place of birth: Chippendale, NSW Date of issue: rded in a Register in the Date of issue: 01 January 2013 November 2018 hereby certify that this is a true copy of particulars reco Deaths and Marriages NSW I I hereby certify that this is a true copy of particulars Registry of Births Registry of Births Deaths and Marriages NSW ommonwealth of Australia. in the Register in the State of New South Wales, State of New South Wales, in the C in the Commonwealth of Australia. Date of issue: 1 August 201

Marriages, Date of issue: 1 August 2016 Issued by the Registry of Births, Deaths and Deaths and Marriages NSW Registry of Births Deaths and Marriages NSW cate Registry of Births New South Wales, Australia. This Commemorative certifi (e.g. , change of name certificate or deed poll). ontain security features and organisations does not c Issued by the Registry of Births Deaths and a proof of identity document. Marriages , may not accept it as Marriages, Issued by the Registry of Births, Deaths and New South Wales, Australia. e certificate This Commemorative certificate does not New South Wales, Australia. This Commemorativ nisation s contain security features and organisations does no t contain security features and orga it as a proof of identity document. not accept it as a proof of identity document.may may not accept

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Issued by the Registry of Births Deaths and Marriages, New South Wales, Australia. This Commemorative certificate does not contain security features and organisations may not accept it as a proof of identity document.

Form 7 06/2020 ABN 81 913 830 179 Birth CertificateApplication GPO Box 30 Sydney NSW 2001 Tel: 13 77 88

YOU CAN COMPLETE THIS APPLICATION ONLINE AT: www.nsw.gov.au/bdm

PRINT clearly in BLACK pen and complete all details. Do you require Priority processing* of your application?Yes * Priority processing and Passport options are only for standard Do you require copy of the certificate* sent to an Australian passport office/DFAT Yesoffice? certifcates and not commemorative. See website for fees. Passport/DFAT office name and the location:You must have already made arrangements with the Passport/DFAT office

What quantity of certificate/s do you require? Standard birth certificate/s (enter number) For NRL certificates you can add your Club membership number and year you joined the Club. Commemorative certificate/s (enter number) Enter description e.g. 1 Fauna and 1 NRL Sharks (Member 123456 joined 1988) Commemorative

Reason certificate is required Your relationship to the registered person (e.g. passport, school) (e.g. self, parent, child)

APPLICANT’S DETAILS (person completing this form). Please provide copies of three forms of current identification with your application.

Family name

First given name Other given name/s

Company name Company reference number (If applicable) (If applicable) Current address Suburb/Town

State/Territory Postcode Country

Postal address (if different from above) Suburb/Town State/Territory Postcode Country

Phone number Email International Registered Post

I certify that I understand the provisions overpage Signature ✗ on Identification, Privacy & Disclosure and that of applicant the information I have provided is true and correct.

DETAILS OF BIRTH CERTIFICATE REQUIRED (This person must have been born or adopted in NSW) Registration number Date of birth* dd / mm / yyyy Present age / (If known) *If date unknown, period to be searched: From dd / mm / yyyy To dd / mm / yyyy (Note: Each extra 10 year search or part thereof incurs a cost) Names of registered person Family name Family name at birth

First given name Other given name/s

Place of birth (Suburb/Town/City) Parent 1 details Family name Family name at birth (Current) First given name Other given name/s Parent 2 details Family name Family name at birth (Current) First given name Other given name/s

PAYMENT DETAILS (complete this section for mail applications only). Please refer to www.nsw.gov.au/bdm for fees.

Total Amount $ Please debit my: AMEX Mastercard Visa OR Enclosed is a cheque*/money order . *Make cheques payable to NSW Department Card number of Customer Service (non Priority only)

Name Expiry date mm / yy of cardholder A surcharge applies to credit card payments at the Signature rate of 1.4% for AMEX and 0.4% for Mastercard or Visa. of cardholder ✗

Form 7 06/2020