Apply For Birth Certificate
Apply For Birth Certificate
Apply For Birth Certificate
you must still provide at least three types of ID. At least two of these
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or particulars
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Birth: Chippe
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certify that South Wales, Register in true copy or Surname: NSW
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in the State
of New the State of
New South particulars
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Birth: Chippe
ndale,
01 Decem
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gistry
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of Births
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NSW
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New South Registry of Births Deaths Female
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does not contain Australia.This Commemorative in the State
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Australia.
issue: 3
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and organisations
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of Births
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document. Registry of
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it as proof and Marriages
NSW
not accept Citizen
Surname
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Place of
2018 Birth Citizen
March
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• Australian passport
the Registry tain
Issued by tive certificate it as a proof of
identity rela secu
ting
This Commera may not accept Issued
by the
Registry to club rity feat
of Births
Deaths
mem ures
& Marriages,
New South
bers and
Wales,
Australia.
The Registry This Commemorativ hip deta organisa
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of information notcontain may
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to club features
membership and organisations not acce
details. may not
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2016
© The Northcott Society and Cerebral Palsy Alliance
Form 7 06/2020
Birth Certificate Application ABN 81 913 830 179
GPO Box 30 Sydney NSW 2001 Tel: 13 77 88
Commemorative certificate/s (enter number) Enter description e.g. 1 Fauna and 1 NRL Sharks (Member 123456 joined 1988) Commemorative
APPLICANT’S DETAILS (person completing this form). Please provide copies of three forms of current identification with your application.
Family name
DETAILS OF BIRTH CERTIFICATE REQUIRED (This person must have been born or adopted in NSW)
Place of birth
(Suburb/Town/City)
Parent 1 details
Family name Family name at birth
(Current)
Parent 2 details
Family name Family name at birth
(Current)
First given name Other given name/s
PAYMENT DETAILS (complete this section for mail applications only). Please refer to www.nsw.gov.au/bdm for fees.
Total Amount $ . Please debit my: AMEX Mastercard Visa OR Enclosed is a cheque*/money order
*Make cheques payable to NSW Department
Card number of Customer Service (non Priority only)
Signature
of cardholder ✗
rate of 1.4% for AMEX and 0.4% for Mastercard or Visa.