Fillable HSE.IE Birth registration application form (COVID-19)

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HSE.IE Birth registration application form (COVID-19)

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The HSE.IE Birth registration application form (COVID-19) form is 2 pages long and contains:

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  • 36 other fields

Country of origin: IRELAND
File type: PDF

Ireland forms for Health Service Executive

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NOTES FOR COMPLETION OF A BIRTH REGISTRATION FORM
IMPORTANT – PLEASE READ BEFORE COMPLETING THE FORM
This form can be used during the COVID-19 Pandemic. It will allow the birth of the child to be registered without the
parents or a qualified informant attending in person at a civil registration office.
Who can complete and submit this form?
The mother of the child should complete this form.
Can all births be registered?
Yes, all births can be registered. For unmarried parents we will be unable to register the father's detail at this time.
The father's details can be added at a later date.
What about Child Benefit?
Following registration, a Child Benefit payment application will be automatically triggered and the Department of
Employment Affairs and Social Protection will contact the mother.
What if the parents are not married?
The law requires that a declaration must be made by the father of the child who is not married to the mother. The Civil
Registration Service will contact the parents once the COVID-19 Pandemic is over to complete the legal registration
of the father’s details.
What surname should be entered for the child?
If the parents are married, the family surname should be used.
For unmarried parents, the mother’s surname will be used. The surname can be amended at a later date by the
parents when the father’s details are added to the register.
Use a separate form for each child in a multiple birth (such as for twins and triplets).
Why do you need all the information sought on the form?
The information sought on the form is the information the Civil Registration Service is required by law to collect.
Providing incorrect or false information is an offence and a person may be prosecuted for giving it.
Why would I be contacted about this form?
Registration staff may wish to contact the mother or the person completing the form to verify the information given in
the form.
How do I complete the form?
You should open the form or save it to your device/laptop/pc. You may complete the form on your device, then print it
and sign it. If you take an image of the signed form you will be able to e-mail the form back to us. If you do not have
access to a printer you should enter the name(s) of the Informant(s) where the Signature(s) should be entered and
we will contact you later on this. Alternatively you may print the form, complete and sign it and return it by post.
Ideally an image/copy of one of the usual forms of photo ID should be sent with your form.
Who do I send the form to?
The form can be emailed to Births@welfare.ie, posted to your local Civil Registration Office - see www.hse.ie for the
contact details/address, or posted to the General Register Office, Government Offices, Convent Road,
Roscommon, Co. Roscommon F42 VX53.
CIVIL REGISTRATION
SERVICE
De
Forename 2:
Date of Birth:
Place of Birth/Hospital:
Multiple Birth: Yes
Surname:
Former Surname(s) if any:
Occupation:
PPS Number:
Part 1 Child’s Details:
Forename 1:
Other Forenames:
Surname:
Sex:
Part 2 Mother’s Details
Forename:
Birth Surname:
Your Mother’s Birth Surname:
Date of Birth:
Civil Status:
Address:
Place & Country of Birth:
Part 3 Father's Details
Forename:
Birth Surname:
Your Mother’s Birth Surname:
Date of Birth:
Civil Status:
Address:
Place & Country of Birth:
Information to register a birth
This form can be e-mailed to births@welfare.ie, posted to your local Civil Registration Office - see www.hse.ie for
the contact details/address, or posted to the General Register Office, Government Offices, Convent
Road, Roscommon, Co. Roscommon, F42 VX53. Queries can be directed to births@welfare.ie.
Signature(s) of Informant(s):
What is your relationship to the child (Mother/Father):
Telephone Number :
Date:
It is an offence to give false or misleading information to a registrar
For Office Use Only - Notification ID
The Civil Registration Service administers Ireland's system of civil registration. A person is required by law to provide
personal data to register a life event (birth, stillbirth, death or marriage) and personal data may be exchanged with
other public bodies and public authorities where provided by law. A person is required to provide personal data when
applying for certificates of vital events and for searches of indexes to the civil registers. The data policy of the Civil
Registration Service is available at www.gov.ie/deasp/privacystatement or in hard copy on request
Order of Birth:
Date and Place of Marriage, (if appropriate)
Nationality:
Surname:
Former Surname(s) if any
Occupation:
PPSNumber:
Nationality
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HSE.IE Birth registration application form (COVID-19)

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Completed 29 March 2020

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