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Fillable Printable Apply For Family History Certificate

Fillable Printable Apply For Family History Certificate

Apply For Family History Certificate

Apply For Family History Certificate

Form 15 Application for a Family History Certificate Effective as of 8 September 2017
Application for a Family History Certificate(Public records only)
NSW Registry of Births Deaths & Marriages(ABN 30 854 211 521)
PRINT clearly in BLACK or BLUE pen. Please complete all details.
DETAILS OF EVENT REQUIRED(Please choose one event per application)
Date of event: Number in Register (if known)
If Date/Registration Number Unknown - Period to be searched: From To
Note: each extra 10-year search period or part of incurs an additional fee
Name of subjectSubject’s spouse (for marriage certificates only)
Family name
(Before marriage)
Given name(s)
Subject’s Mother (Birth and death certificates only) Subject’s Father (Birth and death certificates only)
Family name
(Before marriage)
Given name(s)
Place of event
(Town/City)
APPLICANT’S DETAILS(person completing this form)
Your family name
Your given name(s)
Your street address Suburb/Town/City
State/Territory Postcode Country
Postal address
Suburb/Town/City
(if different from above)
State/Territory Postcode Country
Phone Number Email address
PAYMENT DETAILS(Complete this section for postal applications only.) See the Fees for Products and Services flyer for prices.
Total Amount (*Cheques are payable to NSW Registry of Births Deaths & Marriages)
Please debit my: AMEXMasterCardVisaor enclosed is a cheque*/money order
Card number
Cardholder name Expiry Date:
Signature of Surcharge applies to credit card payments
cardholder at the rate of 1.4% for AMEX and 0.4% for
MasterCard or Visa
mm / yyyy
Post completed application to:
GPO Box 30, SYDNEY NSW 2001
rmoreaftertheevent
Indicate the quantity you
wish to receive, for example
Death30yearsago
ormoreaftertheevent
Birth100yearsago
ormoreaftertheevent
dd / mm / yyyy
dd / mm / yyyy
1
Marriage50yearsago
ormoreaftertheevent
dd / mm / yyyy
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