Complete on-screen and print
You can complete this form on-screen using the Editable PDF functionality with Adobe Reader
You must still print off the application and sign it by hand
SECTION 5: Proof of identity
We check your details in this form against another identity record
I am ordering my own birth certificate
I am ordering my child's birth certificate
I was born in New Zealand
I was married or entered into a civil union in New Zealand
My child was born in New Zealand
OR include a photocopy of one of the
following identity documents:
BDM93B • Page 3/3
Town or city of marriage or civil union
Date of marriage or civil union
Child's date of birth
Child's full name
SECTION 6: Declaration
My surnameMy first and middle names
My first and middle names at birth (if different) My surname at birth (if different)
Copy from Section 1
I am ordering on behalf of a company, and have included a signed request on company letterhead
I declare that the information above is true and correct. I understand that any person who makes a false statement
will be liable on conviction to a fine or imprisonment, or both. I understand the information on this form is collected
under the Births, Deaths, Marriages, and Relationships Registration Act 1995. As part of processing my request, I
understand that my identification details will be checked against other records held by the Department of Internal
Affairs or other government agencies, as authorised by law. I understand that my name will be recorded on the access
register for any non-historical certificates that I order.
Date signed
My signature
Submit your form
and payment
By mail In person
Certificate Team
Births, Deaths and Marriages
PO Box 10526
Wellington 6143
New Zealand
Visit www.govt.nz/bdmoffices for the
location of offices in Auckland,
Manukau, Wellington, Christchurch,
Sydney and London
My town or city of birth, and country if not NZMy date of birth
Do not send the original
- Passport (NZ or overseas)
- Driver Licence (NZ or overseas)
- 18+ Card (issued by Hospitality NZ)
- NZ Firearms or Dealer’s Licence
- Salvation Army identity certification
- NZ Refugee Travel Document
- NZ Emergency Travel Document
- NZ Certificate of Identity (Issued by
Immigration NZ)
- NZ Certificate of Identity (Issued under the
Passport Act 1992)
- Steps to Freedom document (issued by
Department of Corrections)
Choose one of the following to confirm your identity
Office Use Only B D
- Kiwi Access Card (issued by Hospitality NZ)
