Fillable Printable Apply For Relationship Revoke Withdraw
Fillable Printable Apply For Relationship Revoke Withdraw
Apply For Relationship Revoke Withdraw
Withdraw application to revoke a relationship | Page 1 of 4
Information about how to
withdraw an application to
revoke a registered relationship
Relationship Register Act 2010 (NSW)
1 Complete notice/s
Use black ink and write in BLOCK letters.
All corrections must be initialled. Do not use white out.
■
Joint applicants should complete separate
Notices to withdraw an application to revoke
a registered relationship.
■
Sole applicants to complete Applicant One
Notice to withdraw an application to revoke
a registered relationship.
If you are the sole applicant lodging this notice the
Registry will notify the other registered party.
2 Payment details
■
There is no fee to withdraw, but application fees are
non-refundable.
3 Identification documents (ID)
To protect your privacy, the Registry requires proof
of your identity.
■
Each applicant must provide at least (3) forms of ID,
one of each from categories 1, 2 and 3.
■
If you are unable to provide ID from category 1, you
must still provide at least three (3) forms of ID. At least
one (1) of these must be from category 2 and two (2)
from category 3.
■
If your identity documents do not show your current
residential address. See category 4, these documents
must have been issued within the last three months.
■
All documents must be current.
■
All photocopies of ID must be certified by an
authorised witness as being true and correct copies of
the originals. The following persons can certify your ID.
■
Justice of the Peace
■
Notary Public
■
Legal Practitioner
(holding a current practising certificate)
■
A person authorised to administer an oath under
section 26 of the Oaths Act 1900.
Eligibility
Are you eligible to apply to withdraw an application to revoke a registered relationship in NSW?
Only the parties to a registered relationship can apply to withdraw their application to revoke their registered relationship.
One or both parties may apply.
Instructions
Category 1
If born in Australia:
■
Australian
birth certificate
If born overseas:
■
Australian citizenship
certificate
■
Permanent resident
status eg visa in passport
■
New Zealand
citizenship certificate
■
New Zealand
birth certificate
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
■
Rates notice
■
Lease agreement
■
Recent utility account
with current residential
address
(A Post office box is not
acceptable evidence of
residential address)
Category 2
■
Australian driver’s licence
■
Australian passport
■
Firearms licence
■
Foreign passport
■
Photo ID card from
motor vehicle or driver
licensing authorities
Withdraw application to revoke a relationship | Page 2 of 4
Your right to privacy
The NSW Registry of Births Deaths & Marriages
administers the Births, Deaths and Marriages Registration
Act 1995 (NSW). The information required on this form
is collected under the provisions of this Act and forms
the basis for the withdrawal of an application to revoke
a registered relationship. The relationship register is part
of the civil records of NSW and is a permanent historical
record. The public do not have access to these records.
The information held by the Registry may be used for
statistical purposes and by law enforcement agencies, as
well as other uses provided for by law. Such access for
approved purposes may be granted to other Registries
and certain government agencies (including Passport
Office, Department of Immigration and Border Protection,
and motor vehicle or driver licensing authorities) and to
authorised non-government agencies.
To protect your privacy, the Registry requires proof
of your identity. In line with the Privacy and Personal
Information Protection Act 1998, the Registry is collecting
this information so that it can determine your eligibility to
withdraw an application to revoke a registered relationship,
obtain the requested certificate and to prevent fraud.
For further information on privacy please visit our website
at www.bdm.nsw.gov.au
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 (DFaT), Department of
Immigration and Border Protection (DIBP), 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.
How we deal with your information
How to lodge this application
Please post your application with your identification
and payment to:
NSW Registry of Births Deaths & Marriages
GPO Box 30
Sydney NSW 2001
OR lodge your application in person at a Registry office.
Registry office locations and hours
Monday to Friday 8.00am – 4.30pm
■
35 Regent Street
Chippendale NSW 2008
■
160 Marsden Street
Parramatta NSW 2150
■
95 Tudor Street
Hamilton NSW 2303
Fees and processing times
Please call 13 77 88 for current fees and processing
times or check our website at www.bdm.nsw.gov.au
Enquiries
Phone: 13 77 88
NRS: 1300 555 727
www.bdm.nsw.gov.au
If you require further information or need advice,
interpreting services are available by phoning the
Translating and Interpreting Service (TIS National)
on 131 450
Continued
Information about how to
withdraw an application to
revoke a registered relationship
Withdraw application to revoke a relationship | Page 3 of 4
Relationships Register Act 2010 (NSW)
False representation
If you knowingly provide false information in this notice, you may be guilty of an offence under Section 57 of the Births, Deaths
and Marriages Registration Act 1995.
Section 57 – False representation: A person who makes a representation in an application, notice or document under this Act
or in response to a notice under Section 44 of this Act (Registrar’s powers of inquiry), knowing the representation to be false
or misleading in a material particular, is guilty of an offence.
Maximum penalty: 100 penalty units or 2 years imprisonment, or both.
Official Use Only
Registration No.
Applicant One
If you have applied to revoke a registered relationship and wish to withdraw the application, one or both parties named on the
original application must complete this form. This withdrawal must be made within 90 days of lodging the application to revoke
your registered relationship. There is no fee to withdraw, however application fees paid are non-refundable.
I,
[full name of applicant one on relationship registration]
Date of birth
/ /
Place of birth
of
Residential address [residential address of applicant one]
Address Line 1
Address Line 2
Suburb/Town/City
State/Territory Postcode
Country
hereby request that the application to revoke a registered relationship with:
[full name of applicant two on relationship registration]
be withdrawn from the date of this application.
Applicant One Date (dd/mm/yyyy)
/ /
Please use black ink and BLOCK letters and do not use white out to complete this declaration
signature
Notice to withdraw
an application to revoke
a registered relationship
Withdraw application to revoke a relationship | Page 4 of 4
Official Use Only
Registration No.
Applicant Two
If you have applied to revoke a registered relationship and wish to withdraw the application, one or both parties named on the
original application must complete this form. This withdrawal must be made within 90 days of lodging the application to revoke
your registered relationship. There is no fee to withdraw, however application fees paid are non-refundable.
I,
[full name of applicant two on relationship registration]
Date of birth
/ /
Place of birth
of
Residential address [residential address of applicant one]
Address Line 1
Address Line 2
Suburb/Town/City
State/Territory Postcode
Country
hereby request that the application to revoke a registered relationship with:
[full name of applicant one on relationship registration]
be withdrawn from the date of this application.
Applicant Two Date (dd/mm/yyyy)
/ /
Please use black ink and BLOCK letters and do not use white out to complete this declaration
signature
Relationships Register Act 2010 (NSW)
False representation
If you knowingly provide false information in this notice, you may be guilty of an offence under Section 57 of the Births, Deaths
and Marriages Registration Act 1995.
Section 57 – False representation: A person who makes a representation in an application, notice or document under this Act
or in response to a notice under Section 44 of this Act (Registrar’s powers of inquiry), knowing the representation to be false
or misleading in a material particular, is guilty of an offence.
Maximum penalty: 100 penalty units or 2 years imprisonment, or both.
Notice to withdraw
an application to revoke
a registered relationship
