Sheet 1 of 7
Application to register a Name Change within 2 Years of Birth
BDM36
If the child's birth is registered outside New Zealand use the Application to register a Name Change for person aged
under 18 who has not been married, in a civil union or de facto relationship (BDM122) at
www.govt.nz/bdm
If this is the second name change
If the child’s name has been changed previously then you
must give special reasons as to why it is appropriate to
change their name again. If this is the case explain the
special reasons at question 8 in this form.
You must make true statements
You must make true statements when completing this
application. If you make, or cause to be made, any false
statement you will be liable on conviction to a fine or up to
5 years imprisonment, or both.
How long will it take?
Applications will be processed within 15 working days, from
receiving a correct and complete application (plus postage
time). If you have requested a certificate showing your new
name, it will be issued as soon as the name change has
been processed.
Guidelines about the new name
The new name must consist of one surname and one or
more first names, unless your religious or philosophical
beliefs, or cultural traditions require the person to bear only
one name - in which case attach a letter of explanation.
The new name (or combination of names) may not be
accepted for registration if:
• it might cause offence to a reasonable person; or
• it is unreasonably long (that is, it should be less than 100
characters long, including spaces); or
• without adequate justification, it is, includes, or
resembles, an official title or rank (in which case attach a
letter of explanation); or
• it is not a name (for example, it must not include numbers
or symbols).
Certificate showing the new name
A new Birth Certificate can be ordered for an additonal fee
that will show the new name as well as all previous names.
He tono ki te rēhita i tētahi Panoni Ingoa i roto i te 2 Tau o te Whānautanga
Post the form, appropriate fee(s), and evidence as applicable, to one of:
New Zealand Sydney London
Name Change Team
Births, Deaths and Marriages
Department of Internal Affairs
PO Box 10-526
Wellington 6143
New Zealand
Births, Deaths and Marriages
Department of Internal Affairs
GPO Box 365
Sydney
New South Wales 2001
Australia
Births, Deaths and Marriages
Department of Internal Affairs
New Zealand House
80 Haymarket
London SW1Y 4TQ
United Kingdom
Complete on-screen and print
You can complete this form on-screen using the Editable PDF functionality with Adobe Reader.
You must still print off the application and have signed where applicable by hand.
Sheet 2 of 7
All legal guardians must sign
The guardians of the person whose name is to be changed should give all the information requested on this form about
themselves and about that person.
The child’s father and mother are usually joint
guardians
The father and the mother of a child are guardians jointly
of the child unless the child’s mother is the sole guardian
of the child. If the child is legally adopted (by opposite-sex
or same-sex parents) those parents are guardians of the
child.
Father as guardian
The father is usually a guardian of the child if the father’s
particulars were added to the child’s birth information on
or after 1 July 2005 but no later than 24 January 2009.
The mother is the sole guardian
When a child is conceived on or after 1 July 2005, the
child’s mother is the sole guardian of the child if the
mother was not:
• Married to, nor in a civil union with, the father of the child
at any time during the period beginning with the
conception of the child and ending with the birth of the
child; and not
• Living with the father of the child as a de facto partner at
any time during that period.
If the child is born as a result of an assisted reproduction
procedure (such as donor insemination) to a mother
acting alone, and the donor is not the mother’s partner
(i.e. not in a marriage, civil union or de facto relationship),
and the donor does not become the mother’s partner
between conception and notification of the birth for
registration, then the mother is the sole guardian.
Appointment of 1 or more additional guardians
• A testamentary guardian of the child appointed by the
deceased parent under section 26(2) of the Care of
Children Act 2004 or section 7(2) of the Guardianship
Act 1968.
• All Court appointed/approved guardians. A certified copy
of the Court appointment as a guardian should be
attached to this declaration.
A guardian may act alone
• In some circumstances a guardian may act alone if the
other guardian(s) is/are dead, unknown, missing (note
that a guardian is not missing if others know of their
whereabouts but they refuse to tell you), of unsound
mind or unable to act because of a medical condition; or
• If Family Court approval is obtained. Appropriate
evidence must be attached to this declaration (note that
this is not a Parenting or Protection order).
Other parent
If the child was born as a result of an assisted human
reproduction procedure (such as artificial insemination),
and the mother was living in a marriage, civil union or de
facto relationship with a man or a woman who had
consented to her undergoing the procedure, and the
man’s or woman’s name is recorded on the child’s birth
registration, then that man or woman must also sign this
declaration.
Privacy Statement
The information provided on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 1995
(the “BDMRR Act). A person who makes, or causes to be made, a false declaration on this form will be liable on conviction to a
fine or term of imprisonment, or both. The information will be held on a public register, and may generally be accessed by any
person on application (e.g. as a certificate or printout). The Births, Deaths, Marriages, Citizenship, Authentications and
Translations office may also release it to certain government agencies and foreign registration authorities, as authorised by law.
The BDMRR Act governs access to registered information. Information about your rights to access and, where appropriate, correct
the information is available on our website www.govt.nz/bdm or Freephone 0800 22 52 52.
Contact Details
Births, Deaths, Marriages, Citizenship, Authentications and Translations:
• Website www.govt.nz/bdm
• Freephone 0800 22 52 52 (New Zealand only). If overseas phone + 64
9 339 0852
• Email
bdm.nz@dia.govt.nz
Sheet 3 of 7
BDM36
1. Old name
Name at birth is (if legally adopted then enter the names given after the adoption)
Surname
All first and middle names
If the guardians have previously registered a name change for the child in New Zealand or overseas. The name below is the
name changing from, if it is different from the name at birth
Surname of most recently registered name change
All first and middle names of most recently registered name change
2. Date of birth
YearMonthDay
Date of birth
3. Place of birth
Town or City of birth
Country of birth (if not New Zealand)
Last updated: 9 December 2019
4. New name (the new name must comply with the “Guidelines about the new name” in the notes pages at the start of
this application)
Surname of the new name
All first and middle names
Application to register a Name Change within 2 Years of Birth
He tono ki te rēhita i tētahi Panoni Ingoa i roto i te 2 Tau o te Whānautanga
9/12/19
Sheet 4 of 7
We are acting together to complete this application --> Go to question 6
5. If acting alone as a guardian
I, as the child's mother, am the sole guardian because the child
was conceived before 1 July 2005 and I was not married to, nor
in a civil union with, the father of the child at any time during the
period beginning with the conception of the child and ending with
the birth of the child; and I was not living with the father of the child
as a de facto partner at the time the child was born, and none of
the exceptions apply
I, as the child’s mother, am the sole guardian because the child
was conceived on or after 1 July 2005 and I was not married to,
nor in a civil union with, the father of the child at any time during
the period beginning with the conception of the child and ending
with the birth of the child; and I was not living with the father of the
child as a de facto partner at any time during that period, and none
of the exceptions apply
The guardian(s) is/are missing
Exceptions:
• The mother and father jointly registered the birth
on or after 1 July 2005 by completing and signing
the Notification of Birth for Registration form
(BDM27).
• The father’s particulars were included in the
child’s birth information on or after 1 July 2005
but no later than 24 January 2009.
• A testamentary guardian of the child has been
appointed by the deceased parent under section
26(2) of the Care of Children Act 2004 or section
7(2) of the Guardianship Act 1968.
• The Court has appointed any other person(s) a
guardian.
State the recent actions within the last 2 months that you have taken to contact the other guardian(s) and include the date you
tried to contact them. This includes searching the electoral roles, the Internet, asking family and friends or former employers. You
must also state that you and all the people that know the guardian (which you have contacted) have no way of contacting them:
I/we searched the electoral roles on date (DD/MM/YYYY)
I/we searched the Internet on date (DD/MM/YYYY)
I/we asked family members on date (DD/MM/YYYY)
I/we asked friends on date (DD/MM/YYYY)
I/we asked their employers on date (DD/MM/YYYY)
I/we and all people who known the guardian(s), who I/we have contacted, have no way of contacting the guardian(s)
One or more of the above do not apply - State why:
I, as the child’s mother, am the sole guardian because the child was born as a result of an assisted reproduction procedure
(such as donor insemination) to me acting alone, and the donor is not my partner (i.e. not in a marriage, civil union or de facto
relationship), and the donor did not become my partner between conception and notification of the birth for registration.
The guardian(s) is/are dead - If died in New Zealand, enter the deceased’s name, date of death and place of death.
If died overseas, include a certified true copy of the deceased’s death certificate:
Deceased's full name
Date of death (DD/MM/YYYY)
Place of death
The Family Court has given consent for me to act alone - Provide a copy of the Family Court order (not a Parenting order,
previously known as a Custody order)
The guardian is unable to act because of a medical condition or they are of unsound mind - Provide evidence from a
Registered Medical Doctor
Sheet 5 of 7
6. Your full name, occupation and residential address
Guardian 1’s First names
Guardian 1’s Surname
Relationship to child (e.g. mother/father) Relationship to child (e.g. mother/father)
Guardian 2’s Surname
Guardian 2’s First names
Residential address - this is not a PO Box Residential address - this is not a PO Box
Flat no Street no Street
Suburb or rural locality
City, town or district Postcode
Country (if not New Zealand)
Flat no Street no Street
Suburb or rural locality
City, town or district Postcode
Country (if not New Zealand)
Copy Guardian
1's address
• I authorise any necessary additional enquiries including the disclosure of personal information about myself and the person whose
name is being changed for the purpose of determining eligibility for this name change application. My authorisation includes any
information held by the Department of Internal Affairs or another NZ government agency.
• If I submit an application for New Zealand citizenship or a New Zealand passport at the same time as this application is submitted, I
authorise any necessary additional enquiries including the disclosure of personal information about myself and the person whose
name is being changed so both applications can be processed.
I/We solemnly and sincerely declare that the information in this application is true, accurate and complete.
8. Signatures
Guardian 1’s Signature
Guardian 2’s Signature
Date signed (DD/MM/YYYY)
Date signed (DD/MM/YYYY)
7. If this is the second name change explain why you are applying again
Guardian 1’s best phone number
Guardian 1’s email Guardian 2’s email
Guardian 2’s best phone number
If there are more than two guardians continue on separate form
If there are more than two guardians continue on separate form
Sheet 6 of 7
9. Fees and Payment details
Application fee to register a name change
If a certificate is required to show the new name:
Charge my credit card
Do not post cash
Do not post us your card
VISA Mastercard AMEX Prezzy Card
Card Number
Expiry Date
Cardholder's name Cardholder's signature
Delivery Address, if ordering a certificate
Flat no Street no Street
Suburb or rural locality
City, town or district Postcode
Country (if not New Zealand)
Guardian 1's address Guardian 2's address
Copy:
Pictorial certificates will be posted flat in an A4 size reinforced
envelope. Standard certificates will be folded into a standard DLE
envelope with address details printed on the back of the certificate.
Standard &
Forest
Standard &
Beach
Forest Beach Standard
For a limited time only:
'All Blacks'
NZ Birth Certificate
Two certificate package
$55.00
Enter quantity below
Two certificate package
$55.00
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$35.00 each
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$33.00 each
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Standard and
All Blacks package
$55.00
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$35.00 each
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I choose the following method to pay for the order:
Courier fee
(optional)
To a New Zealand address $5
In list below number in brackets is
estimated delivery in working days
To an overseas address >>>
First name(s) Surname
$55.00
>> Select country from list<<
Sheet 7 of 7
10. Human Assisted Reproductive Technology (HART) Register
HART Register (optional) - Only complete and return this page if it is applicable
This section only applies if the person whose name is being changed was born as a result of an assisted reproductive
technology procedure using donated sperm, eggs or embryos through a fertility clinic. If information has been provided to Births,
Deaths and Marriages for inclusion on the HART Register, it will be updated to include the person’s new name. This means that
up-to-date information will be provided to persons who are authorised to access your information under the Human Assisted
Reproductive Technology Act 2004.
Are you a donor or person born as a result of a HART procedure?
Yes, the person whose name is being changed was born as a result of a HART procedure whose details are recorded on
the HART Register
If the birth occurred as a result of a donation made after 21 August 2005, information will also be held by the fertility clinic. We can
send information about the name change to the fertility clinic, so that the clinic’s records can be updated.
Consent for new name to be sent to clinic
Yes. I consent to the new name being sent to the fertility clinic named below that holds the information
Fertility clinic name
Click here to print
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