Fill - Free fillable Application to register a relationship (New South Wales) PDF form

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 1 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

General information

Eligibility

To apply to register your relationship in NSW

both partners must be:

• over 18 years of age;

• not married to each other or anyone else;

• not already in a registered relationship

under this Act or in another state or

territory in Australia;

• not in a relationship with another person;

• not related by family.

At least one partner must reside in NSW.

Neither partner is required to be a (temporary

or permanent) resident of Australia.

The 28-day cooling off period

Once your application has been checked and

everything is complete and correct, it can be

processed.

There is

a cooling off period before the

relationship is registered and a certificate

issued.

To cancel your application to register a

relationship, you can lodge a Notice to

withdraw as long as the relationship is not

registered (page 11).

• Only the partners applying to register their

relationship can apply to withdraw.

• One or both partners may apply.

• There is no fee to withdraw, however the

relationship registration fee is non-

refundable.

• Partner(s) who lodge a notice to withdraw

must provide three forms of identification.

Identification documents

Three forms of identity are required for each

partner.

• One partner must also show proof of

residency in NSW.

• All documents must be in English

(provide accredited translation if necessary).

Applying by post

• An authorised witness must certify each

photocopy to say it is a true copy of the

original document.

Applying in person

• Original identification is required, if you are

applying in person.

Authorised witness

The following authorised witnesses can certify

identity documents and witness the signing of a

statutory declaration:

• Justice of the Peace (JP).

Find a JP at: www.jp.nsw.gov.au

• Public Notary

• Legal practitioner – Solicitor/Barrister (holding

a current Australian practising certificate)

• British or Australian Consular Officer;

Judge or Magistrate.

Statutory Declarations

• An authorised witness must confirm your

identity before the declaration is made.

• They will need an identity document from you

such as an Australian passport, Australian

birth certificate, or driver licence, etc.

• A statutory declaration must be completed by

each partner.

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 2 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Your right to

privacy

Privacy

The information required on this form is

collected under the Relationship Register

Act 2010 and the BDMR Act 1995. The

relationship register is part of the civil

records of NSW and a permanent

historical record. The public do not have

access to these records.

Information held by the Registry may be

used for statistical purposes and by law

enforcement agencies, as well as other

uses provided for by law. Such access for

approved purposes may be granted to

other Registries and certain government

and authorised non-government

agencies.

The Registry requires proof of your

identity to protect your privacy. We collect

this information in line with the Privacy

and Personal Information Protection Act

1998, to determine your eligibility to

certificate and to prevent fraud. All

documents are scanned and retained in

the Registry’s system and all copies are

destroyed.

Disclosure of information

When you complete this application form,

understand that you have consented to

the release of information provided by

you, to those agencies which may be able

to validate that information in support of

your application. It is extremely important

that all your identity documents are

accurate and reflect your correct identity

information.

Documents provided as proof of identity

may have their authenticity verified

through the online National Document

Verification Service (DVS).

For more information, please see our

policy on the website: Your Right to

Privacy

Quick Checklist

Before you lodge, check everything is right.

To apply to register a relationship

 both partners must complete: Parts 1-6

 both partners must provide the required

identification (page 3).

 provide payment details (page 9).

 one partner to prove NSW residency (page 4)

To lodge a notice to withdraw

(cancel your application)

 within the 28-day cooling off period.

 at least one partner must complete a

declaration (page 11).

 at least one partner must provide the required

identification (page 3).

Options to lodge

By post

Please attach clear copies certified by

an authorised witness. Do not mail originals.

•

NSW Registry of Births Deaths & Marriages

GPO Box 30, Sydney NSW 2001

In Person

Please provide original ID to be certified and ha

Parts 3 and 6 signed before lodging in person.

•

At a Registry BDM office.

Monday to Friday: 8:00am – 4:30pm

•

At a Service NSW Service Centre.

www.service.nsw.gov.au

BDM Office Locations

•

35 Regent Street Chippendale NSW 2008

•

160 Marsden Street Parramatta NSW 2150

Contacting Us - Phone: 13 77 88

Service NSW | Monday to Friday (7am–7pm)

• NRS: 1300 555 727

(Speech/hearing impaired)

• TIS: 131 450

(Translating/interpreting service)

www.bdm.nsw.gov.au

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 3 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Identification for each partner

This section is to apply to register a relationship (or withdraw).

• You must provide three forms of identification, one of each from categories 1, 2 and 3.

If you are unable to provide identification from category 1, you must still provide at least three

forms of identification. At least one of these must be from category 2 and two from category 3.

• The person who is residing in NSW must provide at least one identification document

containing a current NSW residential address (see category 4).

• All identification must be current (not expired). Utility bills or rate notices must have been

issued within the last three months.

• Identity documents issued by overseas authorities must be translated into English by an

accredited translator, i.e. National Accreditation Authority for Translators and Interpreters

(NAATI).

• If applying in person, you must bring the original documents.

• If applying by post, you must enclose certified photocopies of each identity document. Do not

send original documents with your application. See Page 1 for a list of Authorised Witnesses.

A certified identity document is a photocopy which an Authorised Witness says is a true copy

of the original.

Category 1

If born in Australia:

 An Australian birth certificate

If born overseas:

 New Zealand citizenship certificate

 New Zealand birth certificate

 Australian citizenship certificate

 ImmiCard

 Certificate of registration by descent

Category 2

 Australian driver licence

 Australian passport

 Australian firearm licence

 Foreign passport

 Photo Card issued by a government agency

 Visa

Category 3

 Medicare card

 Credit or debit card

 Centrelink card

 Australian Department of Veteran’s Affairs

card

 Australian security guard licence or crowd

control licence

 Student or tertiary identity card

 Overseas birth certificate

Category 4

(For acceptable documents in Category 4,

please see the next page.)

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 4 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Category 4 – Proof of residency in NSW

At least one partner must reside in NSW and must provide an identity document from Category 4

with a current residential address.

Alternatively, the partner can provide either a current NSW driver licence or a current NSW photo

card ID. This would be both a Category 2 and Category 4 document.

For proof of residential address, bank statements and any document with a Post Office Box are

not accepted.

Examples of documents

These may include, but are not limited to the following types of documents.

Do you own your own home?

 Rates notices

 Water rates

 Utility bills

 Land valuation certificate

 Home insurance papers

Or, do you rent your home?

 Agent lease agreement with rental history

ledger

 Bond lodgement notice

 Content insurance papers

 Utility bills

 Department of Housing rental ledger

Do you work?

 ATO Notice of Assessment

Or, are you currently unemployed?

 Centrelink payment advice

 Centrelink ledger, with address history

 University / TAFE transcripts

Do you own a vehicle?

 Insurance papers

 Registration papers

 E-toll statements

 Infringement notices

What other documents do you have?

 Other government letters

 Electoral enrolment confirmation

 Superannuation documents

 Private health care statements

Note: If you change your residential address within the 28-day cooling off period, you must notify

the Registry in writing with a certified copy of your updated Driver Licence or Centrelink Card or

any documents from Category 4 to minimise delays.

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 5 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Partner ONE

PART 1: Details

PART 2: Marital Status & Parents

Family name

Current marital status

Never validly married

Family name at birth

De facto

Given name(s)

Mother or Parent family name

Mother or Parent family name at their birth (maiden

Dat

e of birth

Sex

Male

dd / mm / yyyy

Female

Mother or Parent given names

her

Place of birth: City/State

Father or Parent family name

ace of birth: Country

Father or Parent family name at their birth (maiden)

cupation

Father or Parent given names

Current residential address

Unit Number

Suburb/Town/City

False representation

If you knowingly provide false information in this

application, you may be guilty of an offence under

State/Territory Postcode

Section 57 of the BDMR Act.

False representation: A person who makes a

representation in an application, notice or

Country

document under this Act or in response to a

notice under Section 44 of this Act (Registrar’s

powers of inquiry), knowing the representation to

Daytime contact number

be false or misleading in a material particular, is

guilty of an offence. Maximum penalty: 100

penalty units or 2 years imprisonment, or both.

)

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 6 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

PART 3: Partner ONE - Statutory Declaration

I declare that: (NOTE: declaration must be completed in the presence of an authorised witness)

I consent to the relationship being registered in the I have read and understand all the instructions in this

state of NSW.

document including Your Right to Privacy and

I declare that all statements in this declaration are true

Disclosure of Information.

and correct:

I understand it is an offence to make false or misleading

•

representations in this declaration and penalties may

I am 18 years of age or above; I am not rel

ated

apply.

by family to the other person in this

relationship; I am not married.

I understand this form becomes the property of NSW

•

I am not registered under this Act or a

Registry of Births Deaths & Marriages who may confirm or

corresponding law as being in a registered

verify the information provided and may disclose to

relationship or an interstate registered

persons or bodies with adequate entitlement the

relationship.

information under the Relationships Register Act 2010 or

Access to information contained in the Register Policy.

Partner ONE: Full name

I declare for the purposes of the Relationships Register Act 2010 that I am in a relationship with:

Partner TWO full name

Partner ONE Signature (signed in the presence of an authorised witness*) Date signed

dd/mm/yyyy

AUTHORISED WITNESS: I certified the following matters concerning the making of this statutory declaration by

the person who made it (*please cross out any text that does not apply):

*I saw the face of the person OR * I did not see the face of the person because the person was wearing a face

covering, but I am satisfied that the person had a special justification for not removing the covering, and

*I have known the person for at least 12 months OR * I have not known the person for at least 12 months, but I

confirmed the person’s identity using an identification document and the document I relied on was:

ID document sighted

Declared at

(suburb/location) in the state of on

dd / mm / yyyy

Before me (signature of authorised witness) Full name of authorised witness (BLOCK LETTERS)

Address of authorised witness

Suburb/Town/City Postcode Country

Daytime contact number Email

Tick the correct title of authorised witness

Justice of the Peace (write JP No.) Legal Practitioner

(with current Australian

practising certificate)

British Consular Officer Judge/Magistrate Public Notary

Australian Consular Officer

Note: * the date signed and the date declared must be the

same day, having been dealt with within minutes of each other.

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 7 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Partner TWO

PART 4: Details

PART 5: Marital Status & Parents

Family name

Cur

rent marital status

Never validly married

Family name at birth

De facto

Given name(s)

Mother or Parent family name

Mother or Parent family name at their birth (maiden)

Date of birth

Sex

Male

dd / mm / yyyy

Female

Mother or Parent given names

Other

Place of birth: City/State

Father or Parent family name

Place of b

irth: Country

Father or Parent family name at their birth (maiden)

ccupation

Father or Parent given names

Current residential address

Unit Number

Suburb/Town/City

False representation

If you knowingly provide false information in this

State/Territory Pos

tcode

application, you may be guilty of an offence under

Section 57 of the BDMR Act.

Country

False representation: A person who makes a

representation in an application, notice or

document under this Act or in response to a

noti

ce under Section 44 of this Act (Registrar’s

Daytime contact number

powers of inquiry), knowing the representation to

be false or misleading in a material particular, is

guilty of an offence. Maximum penalty: 100

penalty units or 2 years imprisonment, or both.

Application to register

a relationship

Relationships Register Act 2010 (NSW)

Page 8 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

PART 6: Partner TWO - Statutory Declaration

I declare that: (NOTE: declaration must be completed in the presence of an authorised witness)

I consent to the relationship being registered in the I have read and understand all the instructions in this

state of NSW.

document including ‘Your Right to Privacy’ and

I declare that all statements in this declaration are true

‘Disclosure of Information’.

and correct:

I understand it is an offence to make false or misleading

•

representations in this declaration and penalties may

I am 18 years of age or above; I am not related

apply.

by family to the other person in this

relationship; I am not married.

I understand this form becomes the property of NSW

•

I am not registered under this Act or a

Registry of Births Deaths & Marriages who may confirm or

corresponding law as being in a registered

verify the information provided and may disclose to

relationship or an interstate registered

persons or bodies with adequate entitlement the

relationship.

information under the Relationships Register Act 2010 or

Access to information contained in the Register Policy.

Partner TWO: Full name

I declare for the purposes of the Relationships Register Act 2010 that I am in a relationship with:

Partner ONE full name

Partner TWO Signature (signed in the presence of an authorised witness*) Date signed

dd/mm/yyyy

AUTHORISED WITNESS: I certified the following matters concerning the making of this statutory declaration by

the person who made it (*please cross out any text that does not apply):

*I saw the face of the person OR * I did not see the face of the person because the person was wearing a face

covering, but I am satisfied that the person had a special justification for not removing the covering, and

*I have known the person for at least 12 months OR * I have not known the person for at least 12 months, but I

confirmed the person’s identity using an identification document and the document I relied on was:

ID document sighted

Declared at

(suburb/location) in the state of on

dd/mm/yyyy

Before me (signature of authorised witness) Full name of authorised witness (BLOCK LETTERS)

Address of authorised witness

Suburb/Town/City Postcode Country

Daytime contact number Email

Tick the correct title of authorised witness

Justice of the Peace (write JP No.) Legal Practitioner

(with current Australian

practising certificate)

British Consular Officer Judge/Magistrate Public Notary

Note: * the date signed and the date declared must be the

Australian Consular Officer

same day, having been dealt with within minutes of each other.

Page 9 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Payment details to

Relationships Register Act 2010 (NSW)

PRINT clearly in BLACK or BLUE pen. Complete all details.

Certificates will be mailed to you and incur a postage and handling fee.

Payment includes (non-refundable) application fee and Relationship certificate.

Do you require a letter confirming you have lodged this application?

YES (Fee applies)

What quantity of Standard relationship certificate/s do you require? e.g.1 (enter number)

Optional: Add Commemorative relationship certificate/s: ‘Sydney Harbour’

‘Opera House’

Optional: Do you wish to organise a Relationship Ceremony with the Registry?

(Fee applies)

If yes, see next page for details and choose: Chippendale or Parramatta

Reason certificate is required (e.g. visa) Your relationship to the person registered (e.g. self)

APPLICANT DETAILS

Family name

Given name(s)

Address Suburb/Town/City

State/Territory Postcode Country

Postal Address Suburb/Town/City

(if different)

State/Territory

Postcode

Country

Phone number

Email address

Signature

International Registered Post

of applicant

(if required)

DETAILS OF PARTNERS REGISTERING A RELATIONSHIP

Partner ONE

Family name Given name/s

Date of birth

dd / mm / yyyy

Partner TWO

Family name Given name/s

Date of birth

dd / mm / yyyy

PAYMENT DETAILS (Complete this section for all mail applications). Refer to fees at: bdm.nsw.gov.au

*Cheques payable to NSW Registry of Births Deaths & Marriages

Please debit: AMEX Mastercard Visa or enclosed is a cheque*/money order

Expiry date

mm / yyyy

Total Amount $

Signature of

cardholder

Surcharge applies to credit card payments at the rate

of 1.4% for AMEX and 0.4% for Mastercard or Visa.

ABN 30 854 211 521. GPO BOX 30 Sydney NSW 2001

Card number

Cardholder name

Page 10 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Relationship ceremony and/or

commemorative certificate/s

Relationships Register Act 2010 (NSW)

Celebrate this special moment!

Why not celebrate this special moment in your life with a relationship ceremony and/or

commemorative relationship certificate/s! These are optional when you register your relationship.

Relationship ceremony

This optional extra brings you together with your loved one (after the 28-day cooling off period is

over) for the presentation of a ceremonial relationship certificate.

If you select the option of a ceremony at the top of page 9, we will contact you to organise a date,

time and venue at one of the Registry’s venues - either at the Chippendale or Parramatta

Registries.

Notes:

A relationship ceremony does not constitute a legal marriage

This information is for Registry ceremonies only and not for weddings performed by

independent Marriage Celebrants.

You can make payment with this form

Please indicate at the top of Page 9 when you order your standard Relationship certificate/s.

See website for details.

Commemorative relationship

certificates

The perfect way to remember your special day!

• can be purchased as a package with a standard

relationship certificate;

• are available to purchase on their own;

• presented in a framing size of 279mm x 355mm;

• printed on archival paper, wrapped in tissue

Opera House Sydney Harbour

paper and packaged in a protective cylinder;

• are for decorative purposes and may not be accepted by organisations as proof of identity.

You can apply for a commemorative relationship certificate if your relationship is registered in NSW.

They are available to either person named on the certificate or their authorised representative.

How to order

To make your selection of beautiful commemorative relationship certificate/s, please indicate at

the top of Page 9 when you order your standard Relationship certificate/s.

Page 11 of 11

Form 3 Application to Register a Relationship. Effective as of 1 July 2019.

Notice to withdraw

Application to register relationship

Relationships Register Act 2010 (NSW)

NOTE: You need to complete this page ONLY if you decide to WITHDRAW

your application for a relationship within the 28-day cooling off period.

Eligibility

• If you have applied to register a relationship and wish to withdraw the application, one OR both

partners na

med on the original application must complete this section of the form.

• Before the relationship has been registered, the applicant may withdraw an application whether or not

the 28 day cooling off period has passed.

• There is no fee to withdraw, however application fees are non-refundable.

I/we would like a refund for the certificate/s fee including registered mail (tick box)

I/we would like a refund for the Relationship Ceremony fee (tick box)

PART 7: Partner ONE Declaration PART 8: Partner TWO Declaration

I (full name of Partner ONE) I (full name of Partner TWO)

Date of birth

dd / mm / yyyy

Place of birth: City/State & Country

Residential address

Suburb/Town/City Postcode

Country

I request that the application to register a

I request that the

application to register a

relationship with:

(full name of Partner TWO)

(full name of Partner ONE)

Be withdrawn from the date of this application

Be withdrawn

from the date of this application

• Certified copies of three forms of my

identification are attached to this form

Partner ONE Signature

Partner TWO Signature

Date signed

dd / mm

/ yyyy

dd / mm / yyyy

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