Fillable Form 1: BIRTH CERTIFICATE ID REQUIRED TO OBTAIN (Government of Newfoundland and Labrador)

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Form 1: BIRTH CERTIFICATE ID REQUIRED TO OBTAIN (Government of Newfoundland and Labrador)

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The Form 1: BIRTH CERTIFICATE ID REQUIRED TO OBTAIN (Government of Newfoundland and Labrador) form is 1 page long and contains:

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  • 4 check-boxes
  • 42 other fields

Country of origin: CANADA
File type: PDF

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ID REQUIRED TO OBTAIN
BIRTH CERTIFICATE
Name
Mailing Address
Address (con't)
City & Province
Bus. Telephone Email
Home Telephone
Signature of Applicant
Reason certificate is required
Postal Code
Second Search
Record no.
Date of registration
Certificate no.
Search
Initials Date
Issued
File no.
Receipt no.
Amount received
Refund
Application for
Birth Certificate
State your relationship to the subject named on the birth certificate you are requesting
Each section must be FULLY completed
Self (you must be at least 16 years of age)
Mother (if child is under 19 years of age)
Other (please specify)
Surname at birth
Place of Birth (city or town)
Surname of father/other parent
Birth surname of mother/other parent
Date of birth
Month
Day
Year
All given names
(Given names)
(Given names)
Certificate required:
*Note: short form will be issued if neither is specified.
Short form does not contain parent’s names
Male
Long form
Female
Short form
NL
If you are not the subject named on the birth certificate requested (or if you are a parent applying for your adult child’s birth
certificate - child 19 years of age or over), written consent is required. Please ensure that this section is signed by the subject
named on the birth certificate or that a signed and dated letter of consent is provided with your application.
I, , authorize that my birth certificate be issued to the applicant stated above.
Signature of subject of birth certificate Date
Subject named on birth certificate
Is this person deceased?
Yes (proof of death must be attached) No
Father or Other Parent
(if child is under 19 years of age)
Send certificate by mail
I will pick up the certificate, or
Please check only one of the following
Acceptable ID presented?
Yes
No
Entitled?
Yes
No
FOR OFFICE USE ONLY
PRIVACY NOTICE
Personal information contained on this form is collected under the authority of the Vital Statistics Act, 2009. The Information provided will be used to fulfill the
requirements of the Vital Statistics Act, 2009 for the release of birth Information. If you have any questions about the collection or use of this information, please
contact a Vital Statistics representative at (709) 729-3308.
APPLICANT INFORMATIONCONSENTBIRTH INFORMATIONFOR OFFICE USE ONLY
Please read important instructions before completing this application
1
2
3
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02 03 008j_2020 12
Vital Statistics Division
Digital Government and Service NL
P. O. Box 8700
St. John’s, NL A1B 4J6
Telephone: (709) 729-3308
Website: http://servicenl.gov.nl.ca
e-mail: vstats@gov.nl.ca
Certified copy of
Legal Change of Name
Certified copy of
Birth Registration
X
I, understand the Government
of Newfoundland and Labrador cannot guarantee that a birth certificate with a
gender marker “x” will be accepted by authorities in other organizations.
Signature
Disclaimer: The Government of Newfoundland and Labrador cannot guarantee that a
birth certificate with a gender marker “x” will be accepted by authorities in other organizations.
If “X” is selected
please complete
this section
Cash
Credit Card Number
Signature
Expiry Date:
Method of Payment
Cheque
Money Order Visa
Mastercard
CVV
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Complete the appropriate sections in full. (All requests with incomplete information must be accompanied by a written
explanation for the omission.)
Payment must be enclosed with the application and can be either by cheque or money order (Canadian Funds) payable to the
Newfoundland Exchequer Account.
Be sure your address and telephone number are correct and are clearly printed.
To avoid delay
Short form birth certificates include the following information:
FULL NAME of the INDIVIDUAL, DATE OF BIRTH, PLACE OF BIRTH, SEX, REGISTRATION
NUMBER, REGISTRATION DATE, and DATE ISSUED.
A long form birth certificate contains all information on the short form certificate and also contains the parents’ names.
Certificates contain information extracted from the original registration filed in our office.
Please indicate whether you wish to receive your certificate by mail or will pick it up.
Who is entitled to apply for a Birth Certificate?
You, if you are the subject of the birth certificate. You must be at least sixteen years of age.
A parent of a child (as established by registration documents or by court documents) until the child reaches the age of
19 years or if the child is incapable because of mental incapacity.
A custodial guardian( if no parent is capable). Proof of guardianship is required.
A person with written authorization from one of the above.
A person with a court order.
A person who requires it to comply with a specific Act or Regulation - proof is required.
When the individual is deceased (proof of death is required):
- the following person; a spouse, cohabitating partner, adult child, parent or adult sibling of the deceased.
- the executor, trustee or administrator of the estate; or
- a person with written authorization from one of the above.
Identification
Any person applying for a certificate is required to present acceptable identification - one piece of photo ID or two pieces of other
ID, at least one of which contains their signature or address. A person who has written authorization to apply for or pick up
someone else’s certificate is required to present their own ID. Persons applying by mail are required to submit photocopies of
their ID documents.
Service is available at:
Vital Statistics Division
Motor Registration Building
149 Smallwood Drive
Mount Pearl, NL A1B 4J6
Telephone: (709) 729-3308
or visit our website: http://www.servicenl.gov.nl.ca
NOTE: All mailed in requests should be sent to Mount Pearl office for processing.
Due to the public health emergency guidelines, requests for documents should be completed online. Documents will be provided
by mail. Where documents are required immediately, counter service is available by appointment only by calling 1-709-729-3308.
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Form 1: BIRTH CERTIFICATE ID REQUIRED TO OBTAIN (Government of Newfoundland and Labrador)

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Completed 3 September 2021

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