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1 Birth CertificateApplicationUse this form to apply for: a standard birth certificate, or a standard birth certificate with commemorative certificate/s, or a commemorative birth certificate on its website for fees and turnaround standard birth certificate is an official certified copy of the registration data held by the Registry, and is commonly used to help establish a person s identit y. Certificate entitlementThis application form is for a birth that occurred in, or was registered in NSW. If you are the person named on the certificate, or a parent of the person named on the certificate, the birth certificate can be issued to you DO meet the above criteria, you must provide: Three types of your own ID (see right).

2 If you DON T meet the above criteria, you must provide: A Letter of Authority giving permission to apply available on our website: Three types of ID from the person giving permission (see right). Three types of your own ID (see right). your Right to PrivacyWhen you apply, you consent to the release of information provided, to those agencies who may be able to validate it. Please read your Right to Privacy Policy at information to a Passports officeSelect this option to send your certificate if you have made prior arrangements with the Australian Passport office, consulate or embassy. This only applies to standard certificates, not commemoratives.

3 Fee applies, see (ID)Please provide at least three types 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 types of ID. At least two of these must be from category 3. All documents except foreign passports must be 1If born in Australia: An Australian birth certificateRecord of immigration status: Citizenship certificate New Zealand citizenship certificate New Zealand birth certificateCategory 2 Australian driver s licence Australian passport Firearms licence Foreign passport Proof of age cardIf your name has changed you may be asked to show proof ( marriage certificate, change of name certificate or deed poll).

4 Category 3 Medicare card Credit or debit card Centrelink or Department of Veterans Affairs card Security guard/Crowd control licence Tertiary education institution ID cardCategory 4 PEACEFULI hereby certify that this is a true copy or particulars recorded in a Register in the State of New South Wales, in the Commonwealth of of issue: 3 August 2017 Issued by the Registry of Births Deaths and Marriages, New South Wales, Commemorative certificate does not contain security features and organisations may not accept it as proof or identity of Births Deaths and Marriages NSWB irth CertificateMaleOliver Harry Lewis05 April 2016 Date of BirthSt George Private Hospital, KogarahPlace of BirthParents.

5 Sonia AnnaGiven NamesLewisSurnameBlacktown, NSWP lace of BirthLuke StevenGiven NamesLewisSurnameBlacktown, NSWP lace of BirthAMONGST THE FLOWERSI hereby certify that this is a true copy or particulars recorded in a Register in the State of New South Wales, in the Commonwealth of of issue: 3 August 2017 Issued by the Registry of Births Deaths and Marriages, New South Wales, Commemorative certificate does not contain security features and organisations may not accept it as proof or identity of Births Deaths and Marriages NSWB irth CertificateFemaleHazel Nicola Lewis05 April 2016 Date of BirthSt George Private Hospital, KogarahPlace of BirthParents:Sonia AnnaGiven NamesLewisSurnameBlacktown, NSWP lace of BirthLuke StevenGiven NamesLewisSurnameBlacktown, NSWP lace of BirthBE BLESSEDFAUNAI ssued by the Registry of Births, Deaths and Marriages, New South Wales, Australia.

6 This Commemorative certificate does not contain security features and organisations may not accept it as a proof of identity Wren CitizenDate of Issue: 01 January 2013I hereby certify that thi s is a true copy of particulars in a Register in the State of New South Wales, in the Commonwealth of of Births, Deaths an d Marriages NSWP arents:Dawn DavidGiven Names Given NamesCitizen CitizenSurname SurnameChippendale, NSW Chippendale, NSWP lace of Birth Place of Birth1 July 2016 Date of BirthFemaleSexArmidalePlace of BirthRABBITOHSI ssued by the Registry of Births, Deaths and Marriages, New South Wales, Australia. This Commemorative certificate does not contain security features and organisations may not accept it as a proof of identity of Issue:I hereby certify that this is a true copy of particulars in the Register in the State of New South Wales, in the Commonwealth of of Births, Deaths and Marriages NSWP arents: Given Names Given Names Surname Surname Place of Birth Place of BirthDate of BirthSexPlace of BirthJennifer Edwina Lenna Citizen01 December 2015 Judith Amber RoseCitizenBlacktownAlex LeeCitizenNew Lambton Heights01 December 2015 FemaleNew Lambton HeightsSTANDARD BIRTH CERTIFCATE (A4 SIZE)KEN DONEDate of birth.

7 29 June 2017 Sex: FemalePARENTSG iven names: SamanthaSurname: O BrianPlace of birth: Sydney, NSWS arah WilsonPlace of birth: Sydney, NSWG iven names: To mSurname: WilsonPlace of birth: Sydney, NSWI hereby certify that this is a true copy or particulars recorded in a Register in the State of New South Wales, in the Commonwealth of of issue: 3 August 2017 Issued by the Registry of Births Deaths and Marriages, New South Wales, Commemorative certificate does not contain security features and organisations may not accept it as proof or identity of Births Deaths and Marriages NSWBANANAS IN PYJAMAS 1 Issued by the Registry of Births Deaths and Marriages, New South Wales, Australia.

8 This Commemorative certificate does not contain security features and organisations may not accept it as a proof of identity document Australian Broadcasting Corporation 2018. Original song by Carey hereby certify that this is a true copy of particulars in the Register in the State of New South Wales, in the Commonwealth of of Births Deaths and Marriages NSWLiam Henry Cameron01 January 2015St MarysMaleJudith Amber RoseAlexander Christian LeeBlacktown, NSWSt Marys, NSWJ onesSmith01 January 2015 Recent utility account with current residential address (issued within last three months)Commemorative birth certificatesCapture the joy of a new birth, or celebrate a birth from many years ago with a commemorative birth certificate.

9 When you complete this form, choose a standard birth certificate only, a commemorative only, or both together. All commemorative birth certificates come in a popular framing size (279mm x 355mm) and are mailed separately to the standard certificate (A4 size).Commemorative certificates do not contain security features and organisations may not accept them as proof of identity. You may need a standard birth certificate for official purposes ( to apply for a driver licence). See for all the latest by postYou can lodge this application GPO Box 30 online at:SYDNEY 2001 Lodging in personPhone: 13 77 88 Registry office locationsService NSW Monday to Friday 8am to Friday (7am 7pm) 35 Regent St, Chippendale Hearing/Speech impaired 160 Marsden St, Parramatta TTY/Voice Call 133 677or at Service NSW service centres NRS 1300 555 and Interpreting TIS National 131 450 NSW Registry of Births Deaths & Marriages ABN 30 854 211 521 GPO Box 30 Sydney NSW 2001 Tel.

10 13 77 88 Birth Certificate Application your certificate will be mailed to you if your application was received by post and will incur a postage and handling fee. PRINT clearly in BLACK pen and complete all details. Do you require Priority processing* of your application? Yes Fee applies, see you like us to fax your certificate* to an Australian passport office/DFAT office? Yes Fee applies, see office name & location: You must have already made arrangements with the Passport/DFAT office* Only applies to standard certificates, not to commemorativesDETAILS OF PERSON COMPLETING THIS FORM. Please provide copies of at least three types of current ID with your name First given name Other given name/s Company name Company reference number (If applicable) (If applicable)Current address Suburb/Town State/Territory Postcode Country Postal address Suburb/Town (if different from above)State/Territory Postcode Country Phone number Email address Signature I certify that I understand the provisions overleaf on Identification, Privacy & Disclosure and that the information I have provided is true and correct.