Fillable Printable Apply For Relationship Certificate
Fillable Printable Apply For Relationship Certificate
Apply For Relationship Certificate
Relationship
Certificate
Application
Certificate entitlement
This application form is for relationships registered in NSW.
A relationship certificate can be applied for, and issued to either
of the partners in the relationship.
Identification (ID)
You must provide at least three forms of ID, one of each from
Categories 1, 2 and 3. If you are unable to provide ID from
categories 1 and 2, you must still provide at least three forms of ID.
At least two of these must be from category 3.
All documents except foreign passports must be current.
Category 1
If born in Australia:
■
An Australian birth certificate
Record of
immigration status:
■
Citizenship certificate
■
New Zealand
citizenship certificate
■
New Zealand
birth certificate
Category 2
■
Australian driver’s licence
■
Australian passport
■
Fir earms licence
■
For eign passport
■
Proof of age card
Category 3
■
Medicare card
■
Credit or debit card
■
Centrelink or Department
of Veterans Affairs card
■
Security guard/
Crowd control licence
■
Tertiary education
institution ID card
Category 4
Justice
Registry of Births
Deaths & Marriages
Lodging in person
View options at our website:
www.bdm.nsw.gov.au
Phone: 13 77 88 NRS: 1300 555 727
Form 16 Relationship Certificate Application. Effective: 16 May 2016.
Your right to privacy
To protect your privacy, the Registry requires proof of your identity.
In line with the NSW Births, Deaths and Marriages Registration
Act 1995 and the Privacy and Personal Information Protection Act
1998, the Registry collects information to determine your eligibility
to obtain a certificate and to prevent fraud. Information may be
used for statistical purposes and by law enforcement agencies,
and other uses by law. For more information on privacy please visit
our website.
Disclosure of information
When you complete this application form, understand that you
have consented to the release of information provided by you,
to those agencies who may be able to validate that information
in support of your application.
This information may be provided to agencies including (but not
limited to) other Registries of Births, Deaths & Marriages, law
enforcement agencies, Department of Foreign Affairs and Trade,
Department of Immigration and Border Protection, and motor
vehicle or driver licensing authorities. Usually these referrals will be
to simply verify the documents or other evidence that you have
provided us in making your application for a certificate. If there are
discrepancies, we may require you to correct any errors with the
issuing agency, before being able to process your application. It is
extremely important that all your identity documents are accurate
and reflect your correct identity information.
Documents provided as proof of identity may have their authenticity
verified through the online Certificate Validation Service (CertValid)
and the National Document Verification Service (DVS). Documents
issued by this office may also be verified by other organisations
using CertValid and/or DVS.
■
Recent utility account
with current residential
address
Lodging by post
GPO Box 30
SYDNEY
NSW 2001
05/16
Justice
Registry of Births
Deaths & Marriages
NSW Registry of Births Deaths & Marriages ABN 30 854 211 521 GPO Box 30 Sydney NSW 2001 Tel: 13 77 88
Payment Details
Application for a relationship certificate
Your certificate will be mailed to you if your application was received by post and will incur a postage and handling fee.
The Registry can issue a standard relationship certificate once a relationship has been registered or revoked.
PRINT clearly in BLACK pen and complete all details.
Do you require Priority processing of your application? Yes
Fee applies, see separate ‘Fees for Products and Services’ flyer.
Please select certificate and quantity you wish to receive e.g.
1
International R
egistered Post
Registered relationship certificate
Revoked relationship certificate
Reason certicate is required Your relationship to the registered person
(e.g. replacement certificate,
(e.g. self)
visa requirement)
APPLICANT’S DETAILS
(details of person completing this form). Please provide copies of at least three (3) forms of current identification with your application.
Family name
First given name Other given name(s)
Company name Company
reference number
(If applicable) (If applicable)
Address Suburb/Town/City
State/Territory Postcode Country
Delivery address Suburb/T
own/City
(If different from above)
State/Territory Postcode Country
Contact number Email
address
Signature
✗
I certify that I understand the pr
ovisions overpage on
of applicant
Identification, Privacy & Disclosure and that
the information I have provided is true and correct.
DETAILS OF RELATIONSHIP
Date of relationship registration
*If date unknown, period to be searched: From To
dd mm yyyy
/ /
dd mm yyyy
/ /
dd mm yyyy
/ /
(Note, each extra 10 year search or part thereof incurs a cost)
Applicant One details
Family name Family name at birth
First given name Other given name(s)
Date of birth
dd mm yyyy
/ /
Applicant Two details
Family name Family name at birth
First given name Other given name(s)
Date of birth
dd mm yyyy
/ /
PAYMENT DETAILS
(complete this section for mail applications only). For schedule of fees, see Fees for Product and Services flyer.
Total Amount $
.
Please debit my: AMEX
MasterCard
Visa OR Enclosed is a cheque*/money order
*Cheques payable to NSW Registry of
Card number
Births Deaths & Marriages (non Priority only)
Name Expiry date
mm yyyy
/
of cardholder
Signature
✗
From 1 July 2016 a surcharge applies to credit card payments
of cardholder
at the rate of 1.4% for AMEX and 0.4% for Mastercard or Visa.
Form 16 Relationship Certificate Application. Effective: 16 May 2016.
✔
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