Fillable Printable Apply Letter Of Authority
Fillable Printable Apply Letter Of Authority
Apply Letter Of Authority
Letter of Authority
giving permission to apply for a certificate
Births Deaths and Marriages Registration Act 1995 (BDMR Act)
Eligibility
If a person is not el igi bl e to apply for and/or coll ect a certificate, t hen the Applicant must complete an Authority to
give permissi on to their Authorised Agent. Attach an authority to the Certificate Applicat i on. Registry records are
confidential and certificates can onl y be issued to person s who are entitled under the Registry’s Access Policy
Identity Require ment s
You MUST prov ide proof of identity for yourself and your Authorised Agent. Three docum ents are required from
you and your agent, one of each from categories 1, 2 and 3. If you cannot provide identification from categories 1
and 2, you must still provide at least three forms of identification. At least two of these must be from category 3.
Category 1
• A
ustralian birth
certificate
• C
itizenship certi
ficate
• I
mmi card
• N
Z birth certifi
cate
• N
Z citizenship
ce
rtificate
Category 2
• A
ustralian driv
er’s Licence
(current)
• A
ustralian passpor
t (current)
• Firearms licence (current)
• F
oreign passport
• P
roof of age card
Category 3
• M
edicare card
• Credit or debit card
• C
entrelink or D
epartment of
Veterans Affairs Card
• S
ecurity guard/Cr
owd control
licence
• T
ertiary Educat
ion ID Card
Category 4
• R
ecent utility
account with
current residential
address
Applicant
(the registe red/ entitled person)
Full Name
Date of birth
Residential address (
PO BOX not accepted)
Daytime telephone number
Email address
I give approval
for my Authorised Agent to
make application for a certificate, or
make application for and collect the
certificate on my behalf.
Certificate required (e.g. birth, death, marriage)
Signature of applicant
Date signed
Authorised Agent
(nominated to appl y for and/or collect the certificate)
Full Name
Date of birth
Residentia
l address (PO BOX not accepted)
Daytime tel
ephone number
Email addr
ess
Company nam
e (if applicable)
Australi
an Business Number (if applicable)
Australi
an Company Number (if applicable)
Signature of
Authorised Agent
Date si
gned
Form 065 Letter of Authority Effective as of 26 Ma y 2016
dd / mm / yyyy
dd / mm / yyyy
dd / mm / yyyy
dd / mm / yyyy
