Office Use Only:
Notification of Birth for Registration of child born in New Zealand
For help completing this form contact us on Freephone 0800 22 52 52
Phone: +64 4 463 9362 (if outside New Zealand)
Note:
(A) The first character of each word must be a capital letter, except where the first letter is lower case. The remainder of
each word must be in lower case. E.g. John Wellington.
(B) You must answer all questions. Do not send us another form if you have already sent us one for your child.
(C) All fees, timelines and entitlements are correct as at the form version date.
Batch Regn Nbr
He whakaaturanga o te Rēhita Whānautanga o te tamaiti i whānau i Aotearoa
BDM27
Use smartstart.services.govt.nz to register the birth online
Why register?
Every birth in New Zealand must be registered by law. Please register the birth of your child as soon as possible. We expect you to register
the birth within two months. Both parents must jointly register the birth, with some exceptions. Birth registration is the first official step that
confirms whether your child is a New Zealand citizen. You will not be sent any confirmation that the birth has been registered, however, you
can purchase a birth certificate (see order form on the last page).
How to register the birth
You may register the birth online at smartstart.services.govt.nz or use this form. Please take care filling out this form as if
you make a mistake you will need to pay for a new birth certificate to be issued, if required. Name change fees will also apply.
Print the names of your child the way you would like them to appear on
a birth certificate.
Leave a space between names or words.
Answer all questions in the form truthfully. It is against the law to give
false information.
Please ensure that all relevant questions are completed.
Registration is free. However there is a fee for a Birth Certificate.
Privacy
Information regarding the registration of your child’s birth is collected under the Births, Deaths, Marriages, and Relationships Registration
Act 1995 (’the Act’). Both parents are primarily responsible for notifying the birth as soon as practicable. It is an offence, punishable by a
fine, to fail or refuse to provide information for the registration of a birth.
The citizenship or immigration details of the parent(s) of a child born on or after 1 January 2006 will be checked against databases held by
the Department of Internal Affairs (Citizenship Office, Passports Office or Births, Deaths and Marriages), the Ministry of Business,
Innovation and Employment (Immigration) and / or with registration authorities in the Cook Islands, Niue or Tokelau (where relevant). The
information will be used to confirm whether your child is a New Zealand citizen by birth.
If you decide to use this form to also apply for an IRD number for your child, Births, Deaths, and Marriages will give the information you
have provided on this form to Inland Revenue for this purpose. After giving the information to Inland Revenue, Births, Deaths and
Marriages will not retain details of your IRD number if you have provided it on this form.
If you have decided to notify the Ministry of Social Development (MSD) of your child’s birth, Births, Deaths and Marriages will provide MSD
with information about the birth when the registration is complete. MSD will use this information to determine how your new baby changes
the benefits and services you are entitled to. After giving the information to MSD, Births Deaths and Marriages will not retain details of your
MSD client number if you provided it on this form.
The birth information collected on this form will be held on a public register. The Act governs access to registered birth information.
Information about a named individual may generally be accessed by any person upon application (e.g. as a certificate or printout).
Information may be released for statistical, or genuine health or demographic research in the public interest, or to certain government
agencies, as authorised by law. Information about why the information is collected, the government agencies that are authorised to receive
the information, and about a person's right to access and, where appropriate, correct the information, is available on our web site
www.govt.nz/bdm, or Freephone 0800 22 52 52.
When you have completed the form, post it to:
Birth Registrations
Births, Deaths and Marriage
PO Box 10526
Wellington 6143
Page 1 of 13 Version date: 14 May 2018
/
/
Child
Child’s names to appear on a Birth Certificate (questions 1 & 2)
Your child must be registered with a surname or family name, and one or more given names.
The name (or combination of names) may not be accepted for registration if, in the opinion of the Registrar-General of Births, Deaths
and Marriages (or the Family Court on appeal);
• 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; or
• it is not a name (for example, it must not consist of or include symbols that cannot meaningfully be expressed in language e.g. / or @).
The name must consist of one name that is designated to be treated as the child's surname or family name, and one or more other names, unless
the religious or philosophical beliefs, or cultural traditions of the person’s parent(s) or living guardian(s) require the child to have only one name.
The child’s name will be registered exactly as entered below, if the name is acceptable for registration. Fees will apply if at a later date you decide
to change or alter the child’s name (and the child’s previous name will appear on the certificate).
1. All first or given name(s) of child
2. Surname or family name of child
3. Sex of child
MaleFemale
4. Was this child alive at birth? No (the child was “stillborn”) Yes
A baby is stillborn if the baby was not alive when born, and:
– weighed 400g or more at birth, or
– was born after the 20th complete week of pregnancy.
The delivery of a foetus in the 20th week of pregnancy or earlier, and which weighs less than 400g is a miscarriage and is not able to be registered.
5. Is this child one of multiple birth of twins, triplets etc? YesNo
1st Triplet
2nd Twin
3rd Triplet2nd Triplet
1st Twin
Other
6. Child's date of birth (DD Month YYYY)
7. Where was the child born?
Hospital
(print hospital name and town)
Other Place
(print full address)
Home birth
(print full address)
Address line 1
Address line 2
Address line 3
If this child was born in a car or ambulance, also give the name of the hospital the mother and new child went to afterwards:
Hospital name
If child born in a hospital, hospital name and town
otherwise
enter address:
Page 2 of 13
8. Is this child a descendant of a New Zealand Māori? No Yes Don't know
Please make sure you tick an answer for the question “Descendant of a New Zealand Māori?” (i.e. do you have any Māori ancestors?). This information will
not appear on the birth certificate.
9. Which ethnic group(s) does this child belong to? Tick the box or box(es) that apply:
Please tick as many boxes as you wish to describe the ethnic group(s) this child belongs to. Do the same when you answer the question for the mother and
father. The information you give about the ethnicity of your child will help other government agencies to get a clear picture of our society so that health,
education and other needs in your area can be planned for.
NZ European
NiueanTongan
Cook Island MāoriSamoanMāori
IndianChinese
Other such as Dutch, Japanese, Tokelauan...
Please state
Mother
10. Mother's name currently known by
In question 10 put all first and given names and all family names or surnames. If any of these names are different from the name on your own birth
registration, please also state the name you were given at birth (question 11). If you were adopted, please enter the name you were given when
you were adopted (in question 11), not your name before you were adopted (if you know that).
All first or given name(s) of mother (name(s) currently known by)
Surname or family name of mother (name(s) currently known by)
Surname or family name of mother (at birth)
All first or given name(s) of mother (at birth)
11. Mother's name given at birth (Fill in only if different from question 10 above)
12. Usual occupation, profession or job of mother (Enter the occupation or job title. You don't need to include the name
of the employer)
13. Mother's date of birth (DD Month YYYY)
14. Mother's place of birth
City/town
Country (if born overseas)
15. Mother's home address
Flat number (if applicable) Street number Street name
City/town or district Post code
Country (if not NZ)
Suburb or locality
Page 3 of 13
16. Is the mother a descendant of a New Zealand Māori? No Yes Don't know
Please make sure you tick an answer for the question “Descendant of a New Zealand Māori?” (i.e. do you have any Māori ancestors?). This
information will not appear on the birth certificate.
17. Which ethnic group(s) does the mother belong to? Tick the box or box(es) that apply:
Please tick as many boxes as you wish to describe the ethnic group(s) you belong to.
NZ European
NiueanTongan
Cook Island MāoriSamoanMāori
IndianChinese
Other such as Dutch, Japanese, Tokelauan...
Please state
18. Citizenship or residency status of mother
Complete the following section to show if you were a New Zealand citizen, New Zealand permanent resident or Australian citizen/permanent
resident, when your child was born. Your details will be checked against databases held by the Department of Internal Affairs, the Ministry of
Business, Innovation and Employment (Immigration), and/or with registration authorities in the Cook Islands, Niue or Tokelau (where relevant).
From 2006, a child born in New Zealand is a New Zealand citizen at birth only if at least one parent is a New Zealand citizen, or is entitled under the
Immigration Act 2009 to be in New Zealand indefinitely (a permanent resident), or is entitled to reside indefinitely in the Cook Islands, Niue or
Tokelau.
Please tick the relevant boxes and provide the necessary information about each parent’s citizenship or immigration status.
If you were born overseas to New Zealand citizen parent(s), or you were born overseas and adopted by New Zealand citizen parent(s), Births,
Deaths and Marriages needs to confirm whether you are a New Zealand citizen by descent.
If your citizenship by descent has been recorded with the Citizenship Office, please state the date of your registration/ confirmation and Citizenship
Certificate number. If you have not applied for registration or confirmation, please either:
• contact the Citizenship Office: Freephone 0800 22 51 51 for registration or confirmation. A fee applies to the process; or
• send documents that show that you were born to a New Zealand citizen parent. Contact the Citizenship Office: Freephone 0800 22 51 51 for
information about the documents that are required.
If you are unsure about your citizenship status, contact the Citizenship Office: Freephone 0800 22 51 51.
If you are unsure about your immigration status, contact the Ministry of Business, Innovation and Employment (Immigration):
• within New Zealand but outside of Auckland: Freephone 0508 558 855
• from Auckland: 09 914 4100
• outside of New Zealand: +64 9 914 4100
Is the mother a New Zealand citizen? No Yes
Mother is either: born in
New Zealand
Niue >>
the Cook Islands >>
Tokelau >>
New Zealand citizen by Descent or Grant
Enter your New Zealand Passport Number
or
Is the mother a
New Zealand permanent resident?
Is the mother a resident of the
Cook Islands, Niue or Tokelau?
Is the mother an Australian citizen
or permanent resident of Australia?
No Yes >>
Yes >>No
No Yes >>
Passport/travel document number you
entered New Zealand on:
19. Mother's contact details if we have queries with this form
Mother's daytime contact number
Mother's alternative contact number
Mother's email address
Page 4 of 13
Father
No
(go to question 32)
Yes
(enter father's details)
Is father known?
If a child was born as a result of an assisted human reproduction procedure (such as artificial insemination), the details in
questions 20 to 29 should be completed as follows:
(a) if the mother married, or entered into a civil union or de facto relationship with, a man who consented to the mother
undergoing the procedure, that man’s details should be entered. Note: The Donor is generally not the father or other
parent.
(b) if the mother married or entered into a civil union or de facto relationship with a woman who consented to the mother
undergoing the procedure, tick the following box, enter the details of the mother’s partner, and complete the details in the
rest of the form wherever details of “Father” are indicated. Her details will be shown on the child’s birth registration and
birth certificates as either “Mother” or “Parent” (instead of “Father”).
If situation (b) applies, tick one box for her preference: Mother Parent
20. Father's name currently known by
In question 20 put all first and given names and all family names or surnames. If any of these names are different from the name on your own birth
registration, please also state the name you were given at birth (question 21). If you were adopted, please enter the name you were given when
you were adopted (in question 21), not your name before you were adopted (if you know that).
All first or given name(s) of father (name(s) currently known by)
Surname or family name of father (name(s) currently known by)
Surname or family name of father (at birth)
All first or given name(s) of father (at birth)
21. Father's name given at birth (Fill in only if different from question 20 above)
22. Usual occupation, profession or job of father (Enter the occupation or job title. You don't need to include the name
of the employer)
23. Father's date of birth (DD Month YYYY)
24. Father's place of birth
City/town
Country (if born overseas)
25. Father's home address
Flat number (if applicable) Street number
Street name
City/town or district Post code
Country (if not NZ)
Suburb or locality
Page 5 of 13
26. Is the father a descendant of a New Zealand Māori? No Yes Don't know
Please make sure you tick an answer for the question “Descendant of a New Zealand Māori?” (i.e. do you have any Māori ancestors?). This information will
not appear on the birth certificate.
27. Which ethnic group(s) does the father belong to? Tick the box or box(es) that apply:
Please tick as many boxes as you wish to describe the ethnic group(s) you belong to.
NZ European
NiueanTongan
Cook Island MāoriSamoanMāori
IndianChinese
Other such as Dutch, Japanese, Tokelauan...
Please state
28. Citizenship or residency status of father
Complete the following section to show if you were a New Zealand citizen, New Zealand permanent resident or Australian citizen/permanent
resident, when your child was born. Your details will be checked against databases held by the Department of Internal Affairs, the Ministry of
Business, Innovation and Employment (Immigration), and/or with registration authorities in the Cook Islands, Niue or Tokelau (where relevant).
From 2006, a child born in New Zealand is a New Zealand citizen at birth only if at least one parent is a New Zealand citizen, or is entitled under the
Immigration Act 2009 to be in New Zealand indefinitely (a permanent resident), or is entitled to reside indefinitely in the Cook Islands, Niue or
Tokelau.
Please tick the relevant boxes and provide the necessary information about each parent’s citizenship or immigration status.
If you were born overseas to New Zealand citizen parent(s), or you were born overseas and adopted by New Zealand citizen parent(s), Births,
Deaths and Marriages needs to confirm whether you are a New Zealand citizen by descent.
If your citizenship by descent has been recorded with the Citizenship Office, please state the date of your registration/ confirmation and Citizenship
Certificate number. If you have not applied for registration or confirmation, please either:
• contact the Citizenship Office: Freephone 0800 22 51 51 for registration or confirmation. A fee applies to the process; or
• send documents that show that you were born to a New Zealand citizen parent. Contact the Citizenship Office: Freephone 0800 22 51 51 for
information about the documents that are required.
If you are unsure about your citizenship status, contact the Citizenship Office: Freephone 0800 22 51 51.
If you are unsure about your immigration status, contact the Ministry of Business, Innovation and Employment (Immigration):
• within New Zealand but outside of Auckland: Freephone 0508 558 855
• from Auckland: 09 914 4100
• outside of New Zealand: +64 9 914 4100
Is the father a New Zealand citizen? No Yes
Father is either: born in
New Zealand
Niue >>
the Cook Islands >>
Tokelau >>
New Zealand citizen by Descent or Grant
Enter your New Zealand Passport Number
or
Is the father a New Zealand
permanent resident?
Is the father a resident of the Cook
Islands, Niue or Tokelau?
Is the father an Australian citizen or
permanent resident of Australia?
No Yes >>
Yes >>No
No Yes >>
Passport/travel document number father
entered New Zealand on:
29. Father's contact details if we have queries with this form
Father's daytime contact number
Father's email address
Father's alternative contact number
Page 6 of 13
Parents
30. Are there other children born from the same parent relationship?
(This means other children with the same mother AND father as the new child. If this is the first child of the relationship, tick the answer No)
No Yes
Complete the following table giving the sex and date of birth for each child, but do not include the child you are
registering now.
Sex
Child was:
Born alive, or was stillborn, or has since died
Date of birth
(DD Month YYYY)
Child 1 Female Male Born alive Stillborn Has since died
Child 2 Female Male Born alive Stillborn Has since died
Child 3 Female Male Born alive Stillborn Has since died
Child 4 Female Male Born alive Stillborn Has since died
Child 5 Female Male Born alive Stillborn Has since died
Child 6 Female Male Born alive Stillborn Has since died
Child 7 Female Male Born alive Stillborn Has since died
Child 8 Female Male Born alive Stillborn Has since died
Child 9 Female Male Born alive Stillborn Has since died
31. What was the parents’ relationship with each other at the time of the child’s birth?
Not every relationship where two people live together (and are not married, nor in a civil union) is a de facto relationship under the law. Being in a
de facto relationship depends on the couple’s circumstances, including the couple’s ages, the length of the relationship, the degree to which the
couple are mutually committed to a shared life together, and the extent to which they make their relationship known publicly, for example, to friends
and family. It is important that you know whether or not you are in a de facto relationship before you tick the de facto relationship box. If you are
unsure whether you are in a de facto relationship, you should get advice from a lawyer.
Married In a civil union In a de facto relationship
Not married or in a civil union or de facto relationship
Place of marriage/civil union: City/town
Country (if solemnised overseas)
Date of marriage/civil union (DD Month YYYY)
Page 7 of 13
Page 8 of 13
Application for Best Start payments
Best Start payments are sometimes referred to as the Best Start tax credit (BSTC)
For all children born on or after 1 July 2018, the principal caregiver (who must be aged 16 or older) will receive up to $60 per
week. Every principal caregiver is entitled to receive this payment in the child’s first year. Payment is for three years and will
reduce in the second and third year if your family income is above $79,000.
Payments will start once Paid Parental Leave (PPL) finishes. If your child was born before 1 July 2018 but had an expected
due date after this, you may have the following options:
· Parental Tax Credit (PTC) – 10 weeks maximum $2,200 or;
· Best Start Tax Credit (BSTC) – up to $60 per week, maximum $3,120 first year.
If you choose Parental Tax Credit, you can’t receive Best Start Tax Credit for that same child.
Complete the information below if you would like to apply to receive Best Start payments.
Note: Payments will start from 1 July 2018. Go to www.ird.govt.nz (search keywords: bstc) for more information.
An IRD number will be created for your child if you choose to get the Best Start payments through Inland Revenue.
32. Do you or your partner want to receive Best Start Tax Credit payments?
Yes
No – Go to Q.43
34. The principal caregiver must be at least 16 years old or over and is responsible for the day to day care of the
child on a permanent basis. Someone caring for a child on a temporary basis, such as in a child care centre, is
not a principal caregiver. To apply for Best Start payments we need to know who the principal caregiver is as
Best Start payments can only be paid to this person. The principal caregiver will need to apply for Best Start.
Who is the child’s principal caregiver?
Mother – Provide the mother's IRD number -->
Father – Provide the father's IRD number -->
Other – Inland Revenue will contact the principal caregiver. Provide their first name(s), surname and their daytime
contact phone below then go to Q.43 to apply for your child’s IRD number
Unknown – Go to Q.43
IRD number
Principle caregivers first and middle names Principle caregivers surname Principle caregivers daytime phone number
35. Does the principal caregiver receive a benefit from the Ministry of Social Development (MSD)?
No
Yes – Go to Q.43
33. Best Start payments are only available for children born on or after, or expected after 1 July 2018.
What was the expected due date of this child? (DD Month YYYY)
38. Shared care is when the care of the child is divided between people in different households for at least a third of
the time. In a shared care situation there will be more than one principal caregiver eligible for Best Start
payments. Does this child live with someone else for more than two days a week (shared care)?
Yes – Provide the contact details of the person that care is shared with so that Inland Revenue have this information if
they need it to process your BestStart application
No
Share care with: First and middle names Share care with: Surname Share care with: Daytime phone number
39. Does the principal caregiver have a spouse or partner living with them?
Yes - Enter the spouse or partner’s first name, surname and IRD number
No – Go to Q.41
40. Is the principal caregiver receiving or intending to apply for Paid Parental Leave (PPL) for this child?
Yes – Note that Best Start payments start once Paid Parental Leave finishes No
41. How often do you want to be paid?
Weekly : $60.00 Fortnightly : $120.00 Yearly (as a lump sum) : $3,120.00
42. Provide your bank account details
Credit union or building society account
reference number (if applicable)
Bank Branch Account number Suffix
Bank account holder's name Reference number
Page 9 of 13
37A. Will the child be a resident and living in New Zealand when the principal caregiver is receiving Best Start
payments?
Best Start and Working for Family payments can only be made to New Zealand tax residents.
You are a tax resident in New Zealand if you:
• are in New Zealand for more than 183 days in any 12-month period and haven't become a non-resident, or
• have a 'permanent place of abode' in New Zealand, or
• are away from New Zealand in the service of the New Zealand government.
Yes – Go to Q.38 No
36. Does the principal caregiver currently receive Working for Families tax credits from Inland Revenue?
Yes – An IRD number will be issued to this child, go to Q.43(a) No
Spouse/partner’s: First and middle names Spouse/partner’s: Surname Spouse/partner’s: IRD number
37B. Has the principal caregiver lived in New Zealand continuously for at least 12 months at any time?
Yes No – Go to Q.43(a)
37C. Will the principal caregiver be a tax resident when receiving Best Start payments?
Yes No – Go to Q.43(a)
Application for your child’s IRD number
If you apply for your child's IRD number, Births, Deaths and Marriages will provide Birth Registration information to Inland
Revenue so that it can create your child’s IRD number and help protect it from misuse.
If you have any questions about requesting an IRD number, go to:
• on how this information is used and protected go to www.ird.govt.nz/about-this-site/privacy/privacy-policy.html
• about applying for an IRD number go to : www.ird.govt.nz/how-to/irdnumbers/individuals/ or
• phone Inland Revenue on 0800 775 247 - keyword “newborn IRD number”
If one of the parents is a New Zealand or Australian citizen, or has New Zealand or Australian permanent residency, or is a
resident of the Cook Islands, Tokelau, or Niue, the easiest way for you to get an IRD number for your child is by using this birth
registration form. It is free to apply for an IRD number and it saves you having to get another set of forms to apply for it later.
You will need an IRD number for your child if you are applying for Working for Families Tax Credits or opening a KiwiSaver
account or bank account in your child’s name.
If you apply for an IRD Number for your child, you should receive it 25 working days after posting a correct and complete Birth
Registration form. The IRD number will arrive separately to your child’s Birth Certificate, if you have requested one.
If none of the parents are New Zealand or Australian citizens, or have New Zealand or Australian permanent residency, or are
a resident of the Cook Islands, Tokelau, or Niue, then you may not be able to apply for an IRD number using this birth
registration form.
43. I wish to apply for an IRD number for my child No Yes
(a) Choose ONE address Inland Revenue should post your child’s IRD number to:
Birth certificate address (if requested on the last page of this form)
Mother’s address (at question 15)
Father’s address (at question 25)
(c) If you have applied for Working for Families Tax Credits for this child
please provide your IRD number:
Inland Revenue will add your child’s IRD number to your application.
If you've already applied for Working for
Families payments for your baby, make
sure you include your own IRD number in
43(c). Inland Revenue needs this to give
you the payments.
When your baby is given an IRD number,
Inland Revenue will add it to your Working
for Families registration details for you.
(b) I also wish to receive my child's IRD number by email: No Yes
Notify the Ministry of Social Development (MSD) of the birth
If you are an existing Ministry of Social Development (MSD) client you should notify MSD to determine how your new baby
changes your benefits and services. You can choose to have Births, Deaths and Marriages notify MSD when the birth is
registered. MSD will then contact you as quickly as possible to discuss how your benefits and services will change. This
means you do not need to provide a birth certificate to MSD and may not need to visit an MSD office.
https://www.workandincome.govt.nz/about-this-site/privacy-disclaimer-and-copyright-information.html
44. I give permission for Births, Deaths and Marriages to notify the Ministry of Social Development of the birth of
my child
I am not an existing MSD client – go to page 11
No, I do not give permission
Yes, I give permission - please provide the
MSD client number of one or both parents:
Disclaimer – The Ministry of Social Development (MSD) will use the birth of child information that you agreed to provide to MSD to
determine eligibility to payments and or services. MSD may need to contact you and / or ask for further verification to help them determine
this. The Ministry of Social Development includes Work and Income, MSD Housing Assessment, Senior Services, StudyLink and other
service lines. The legislation administered by the Ministry of Social Development allows MSD to check the information that you provide.
This may happen when you apply for assistance and at any time after that.
Mother's MSD client number
Father's MSD client number
Page 10 of 13
Signatures (Sign and date)
Both parents must sign the form unless:
a) One parent is:
• Dead
• Unknown
• Missing
• Of unsound mind, or
• Unable to act by virtue of a medical condition, or
b) Requiring the other parent to sign the form would cause unwarranted distress to either of the parents, or
c) The other parent is overseas and it is not possible to obtain their signature within a reasonable period of time. Please note: This exception only
applies to overseas where there is no delivery address or contact details.
d)The child is born as a result of a woman acting alone in an assisted human reproduction procedure and the donor of the ovum, embryo, or semen
(as the case may be) for the pregnancy does not become the partner of the woman after the time of conception but before the birth is notified for
registration. Note: The donor is generally not the father or other parent. If not sure what details to enter contact us.
If any of these circumstances apply, the details of both parents must be entered on the form, except where the other parent is unknown, or where
the child was born as a result of the mother acting alone in an assisted human reproduction procedure.
If one parent has not signed and their details are entered on this form, if able, you should provide evidence that the other person named is the
biological mother/father. That evidence may be a Paternity Order, a Court Declaration, DNA Test Results or statutory declarations from family
members.
Signature of Mother
Date
I declare that the information entered on this form is true and correct
Signature of Father
Date
I declare that the information entered on this form is true and correct
BOTH PARENTS MUST SIGN UNLESS (Tick one box, if applicable). We may contact you for more information.
(a) One parent is any of the following:
Deceased. If died in New Zealand provide the date of death, otherwise attach a copy of the death certificate (with
an English translation where necessary) to this form.
Missing. State below what steps you have taken to contact the other parent. Please include whether or not you
have contacted the other parents’ friends and family or used social media to locate and contact the other parent.
Of unsound mind. Provide evidence from a Registered Medical Doctor and attach it to this form.
Unable to sign the form by virtue of a medical condition. Provide evidence from a Registered Medical Doctor and
attach it to this form.
(e) None of these
(b) Requiring the other parent to sign the form would cause unwarranted distress to either of the parents. Please
state the nature of the parental circumstances on the page below.
(c) The other parent is overseas and it is not possible to obtain their signature within a reasonable period of time.
Please note: This exception only applies to overseas where there is no delivery address or contact details. State
the circumstances below.
(d) The child is born as a result of a woman acting alone in an assisted human reproduction procedure and the donor
of the ovum, embryo, or semen (as the case may be) for the pregnancy does not become the partner of the
woman after the time of conception but before the birth is notified for registration. Provide evidence from a
Registered Medical Doctor or from a fertility clinic and attach it to this form.
Date of death
Page 9 of 11
Page 11 of 13
Other information you want to advise us, if required
If you have further information attach it to this form.
Application to order a birth certificate on the next page
Page 12 of 13
Birth Certificate Order Form
Delivery Address
First names
Surname
Flat number (if applicable) Street number Street name
Suburb or rural locality
City/town Post code
Country (if not NZ)
Send the following certificates
Best contact phone number
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
Enter quantity below
$35.00 each
Enter quantity below
$35.00 each
Enter quantity below
$33.00 each
Enter quantity below
Two certificate package
$55.00
Enter quantity below
$35.00 each
Enter quantity below
Courier fee
(optional)
To a New Zealand address $5
To an overseas address
(Contact us for courier fee)
Courier fee
if to overseas address
$
I enclose a New Zealand cheque or International bankdraft in New Zealand dollars
made out to: The Department of Internal Affairs. Australian money orders made out to
The Department of Internal Affairs can be receipted at the Sydney DIA counter only.
Charge my credit card
You do not need to purchase a birth
certificate if you only require a birth
certificate to verify the birth with MSD.
VISA Mastercard AMEX
Prezzy Card
(a) Card Number
(b) Expiry Date
(c) Cardholder's name
(d) Cardholder's signature
Note: 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.
Page 13 of 13
Once completed, Sign and Post to:
Birth Registrations, Births, Deaths and Marriages, PO Box 10526, Wellington 6143
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome