*** Transcriber's Note: Please set your voice synthesiser to read most punctuation. When you encounter the caret sign (^) at the end of a line, please enter the applicable information, if necessary. *** Department of Internal Affairs – Te Tari Taiwhenua BDM123 Application to register a name change — Aged 15 and under He tono ki te rehita i tetahi panoni ingoa — 15 tau me raro iho Last updated 02 April 2024 You can use this form to register a name change for your child if: • their birth is registered in New Zealand and they are aged 2 to 15, or • their birth is registered outside New Zealand and they are aged 15 or under. Before you apply Who can register a name change? To register a name Change in New Zealand for your child: • your child’s birth must be registered in New Zealand, or • if your child’s birth is registered outside New Zealand, your child must be a New Zealand citizen or entitled, under the Immigration Act 2009, to be in New Zealand indefinitely (for example, as a permanent resident). Guidelines for your child’s new name Your child’s new name must consist of one surname and one or more other names. If your religious or philosophical beliefs, or cultural traditions require your child to only have one name, you will need to attach a letter of explanation. The new name (or combination of names) may not be accepted for registration if it: • might cause offence to a reasonable person • is more than 70 characters long, including spaces, without adequate justification • is, includes, or resembles an official title or rank (in which case attach a letter of explanation), or • is not a name (for example, it must not include numbers or symbols). Timeframe To view our current timeframes for a name change, go to: govt.nz/bdmtimeframes. If you have requested a certificate showing your child’s new name, allow extra time for postage. Contact details Website: govt.nz/bdm/contactus Email: bdm.nz@dia.govt.nz Only use email for enquiries about the form. To return the form, follow the postage instructions at the end of this form. Do not email the completed form to us. True statements If you make, or cause to be made, any false statement or declaration you will be liable, on conviction, to a fine or up to 5 years imprisonment, or both. Requirements You will need to: 1. Provide evidence of your child’s eligibility for a name change (if applicable). 2. Provide a certified true copy of all guardians’ current photo identification. 3. Include supporting documents to establish all guardians’ identity. 4. Have all guardians make a statutory declaration on sections 6–14 of this form. Refer below for further information about these requirements. Include an official English translation of any document that is not in the English language. 1. Proof of your child’s eligibility for a name change If your child’s birth is registered in New Zealand, you do not have to provide evidence of their eligibility. If your child’s birth is registered outside New Zealand you must provide evidence of: • the date and place of their birth, and • their status as a New Zealand citizen or entitled, under the Immigration Act 2009, to be in New Zealand indefinitely (for example, as a permanent resident). Provide a certified true copy of one (or combination if applicable) of the following documents: • New Zealand citizenship certificate • New Zealand passport (photo page only) • New Zealand certificate of identity issued under the Passports Act 1992 with a letter/permit/visa from Immigration New Zealand confirming permanent resident status • Australian passport or other evidence of Australian citizenship • Overseas passport including a resident permit or resident visa issued by Immigration New Zealand • Letter from Immigration New Zealand confirming permanent residence status (only if the letter states your name, date of birth, place of birth and name(s) of parent(s)) • Overseas birth certificate together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status • Notarial certificate (China) that includes names of parent(s) together with a letter/ permit/visa from Immigration New Zealand confirming permanent residence status • Household/Family census register that includes names of parent(s) from an Asian country together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status 2. Your current photo identification All guardians must provide a certified true copy of one of the following. It must include the guardians’ photo. • New Zealand or overseas passport (photo page only) • New Zealand or international driver licence (copy of front and back) • New Zealand or overseas firearms or dealer’s licence • New Zealand or overseas defence force or police service photo identity card • New Zealand emergency travel document • New Zealand certificate of identity (issued under the Passports Act 1992) • New Zealand certificate of identity (issued under the Immigration Act 2009) • New Zealand refugee travel document • Overseas identity card • 18+ card or Kiwi Access Card (issued by Hospitality New Zealand) or overseas proof of age card A certified true copy is a photocopy that has been stamped or endorsed by an authorised person. For example, a solicitor/lawyer, notary public, registrar of the court or Justice of the Peace. This confirms that the copy is a true copy of the original document. If you do not have photo identification, you will also need to fill out a BDM76 Identity referee declaration form and attach it to this application. You can find this form at: govt.nz/name-change-child. You must present your current photo identification or completed BDM76 form (with attached photo) to the person authorised to take a statutory declaration when you sign the declaration in front of them. They can certify your document at the same time. 3. Proof of the use of your identity in the community All guardians must each provide two documents from different sources. These do not need to be certified true copies. For example: • Rates notices • Electoral roll record • Motor vehicle registration • Student or tertiary identity card • Educational certificate or school report • Trade certificate • Steps to Freedom form • Community Services Card • Utility accounts (including gas, water, electricity, mobile or home phone) • Bank statements (including savings, credit or cheque accounts) • Lease or tenancy agreements • Inland Revenue tax number (provide an IR card or statement) • Confirmation of permit status from Immigration New Zealand • Certificate of Approval or licence issued by the Private Security Personnel Licensing Authority 4. Statutory declaration requirements A statutory declaration is a written statement signed in front of an authorised person and declared to be true. The following people are authorised to take a statutory declaration. New Zealand • Registrar of Births, Deaths and Marriages • Justice of the Peace • Registrar or a deputy registrar of the Supreme Court, Court of Appeal, High Court or a District Court • Person enrolled as a barrister and solicitor of the High Court • Any other person authorised by law to administer an oath Commonwealth country other than New Zealand • Commonwealth representative • Justice of the Peace • Notary public • Judge • Commissioner of Oaths • Solicitor of the High Court of New Zealand • A person authorised by law to administer an oath for the purpose of judicial proceeding (examples below) Non-Commonwealth country • Commonwealth representative • Notary public • Judge • Solicitor of the High Court of New Zealand Examples of people authorised by the law of Australia, England, Wales, Ireland, Northern Ireland and Scotland to administer an oath for the purpose of judicial proceeding: Australia Australian Police are not authorised to take this statutory declaration unless you are in the Northern Territory. Australian pharmacists, optometrists and doctors are not authorised to take this statutory declaration. • Judge • Notary public • Justice of the Peace • Solicitor of the High Court of New Zealand • Australian legal practitioner • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative Also, if in South Australia • Commissioner for Affidavits Also, if in Western Australia • A mining registrar appointed under the Mining Act 1978 Also, if in Northern Territory • Commissioner for Oaths (by personal appointment) • Member of the Legislative Assembly • Member of the house of the Parliament of the Commonwealth elected to represent the Territory or a constituency in the Territory • Member of the police force who is 18 years or older Also, if in Queensland • Commissioner for Declarations • Conveyencer England or Wales • Judge • Comissioner of Oaths (by personal appointment) • Notary public • Justice of the Peace • Solicitor of the High Court of New Zealand • Solicitor • Barrister • Legal executive • Licensed conveyancer • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative Ireland or Northern Ireland • Judge • Notary public • Justice of the Peace • Solicitor • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative • Solicitor of the High Court of New Zealand Scotland • Judge • Notary public • Justice of the Peace • Commonwealth representative • Person authorised by the law of that country to administer an oath for the purpose of a judicial proceeding • Solicitor of the High Court of New Zealand 4.1 All guardians must sign All of your child’s guardians should sign the statutory declaration on this form. The child’s father and mother are usually joint guardians The father and the mother of a child are guardians jointly of the child unless the child’s mother is the sole guardian of the child. If the child is legally adopted by opposite-sex or same-sex parents, those parents are guardians of the child through the adoption. Father as guardian The mother and father are both guardians if they jointly registered the birth of the child on or after 1 July 2005 by completing and signing the Notification of Birth for Registration form (BDM27). The father is usually a guardian of the child if the father’s particulars were added to the child’s birth information on or after 1 July 2005 but no later than 24 January 2009. Appointment of 1 or more additional guardians A testamentary guardian of the child appointed by the deceased parent under section 26(2) of the Care of Children Act 2004 or section 7(2) of the Guardianship Act 1968. All Court appointed/approved guardians. A certified copy of the Court appointment as a guardian should be attached to this declaration. A guardian may act alone In some circumstances a guardian may act alone if the other guardian(s) is/are dead, unknown, missing (note that a guardian is not missing if others know of their whereabouts but they refuse to tell you), of unsound mind or unable to act because of a medical condition; or If Family Court approval is obtained. Appropriate evidence must be attached to this declaration (note that this is not a Parenting or Protection order). If the mother is the sole guardian If the child is born as a result of an assisted reproduction procedure (such as donor insemination) to a mother acting alone, and the donor is not the mother’s partner (i.e. not in a marriage, civil union or de facto relationship), and the donor does not become the mother’s partner between conception and notification of the birth for registration, then the mother is the sole guardian. Other parent If the child was born as a result of an assisted human reproduction procedure (such as artificial insemination), and the mother was living in a marriage, civil union or de facto relationship with a man or a woman who had consented to her undergoing the procedure, and the man’s or woman’s name is recorded on the child’s birth registration, then that man or woman must also sign this declaration. BDM123 Application to register a name change — Aged 15 and under | He tono ki te rehita i tetahi panoni ingoa — 15 tau me raro iho How to answer: • You can complete this form by hand or on-screen. • You must still print off the application and sign where applicable by hand. Please read the ‘Before you apply’ section of this application form carefully before you start. If your application is not correct and complete, your application may be delayed or unsuccessful. 1. My child’s name 1a. Name at birth This is the name on your child’s birth certificate. All first and middle names ^ Surname ^ 1b. Name from previously registered name change (if applicable) This applies if your child’s current name is different from your child’s name at birth due to a registered name change. All first and middle names ^ Surname ^ 2. My child’s date of birth Date of birth (dd/mm/yyyy) ^ 3. My child’s place of birth Town or city ^ Country ^ 4. Indicate whether you want your attached documents to be: Securely destroyed (Yes or no) ^ Returned to you (Yes or no) ^ 5. All guardians’ contact details 5a. Guardian 1’s contact details Guardian 1’s full name ^ Guardian 1’s email address ^ Guardian 1’s phone number ^ 5b. Guardian 2’s contact details (if applicable) Guardian 2’s full name ^ Guardian 2’s email address ^ Guardian 2’s phone number ^ 5c. Guardian 3’s contact details (if applicable) Guardian 3’s full name ^ Guardian 3’s email address ^ Guardian 3’s phone number ^ 5d. Guardian 4’s contact details (if applicable) Guardian 4’s full name ^ Guardian 4’s email address ^ Guardian 4’s phone number ^ The next section is the Statutory Declaration. You will need to sign it in front of an authorised person. Refer to ‘Statutory declaration requirements’ above for the list of people authorised to take a Statutory Declaration. Statutory declaration The guardian(s) need to fill out this section. If your child has more than 2 guardians, print a second copy of Sections 6–14 for the additional guardian(s) to fill in and sign. Attach these pages to your application. Take care completing this statutory declaration as you may be required to do it again if there are errors. All corrections must be: • initialled • dated, and • witnessed by a person authorised to take a statutory declaration. By completing this statutory declaration I declare that: • I authorise any necessary additional enquiries including the disclosure of personal information about myself and the person whose name is being changed for the purpose of determining eligibility for this application. My authorisation includes any information held by the Department of Internal Affairs or another New Zealand government agency. Are all guardians acting together to complete this declaration or one guardian acting alone? I am acting alone as a guardian (Yes or no) ^ If you answered yes, fill in Section 6 below We are all guardians acting together (Yes or no) ^ If you answered yes, go to Section 7 6. Acting alone as a guardian There are 6 statements to choose from. Select the statement that applies: Statement 1: I, as the child’s mother, am the sole guardian because the child was conceived on or after 1 July 2005 and I was not married to, nor in a civil union with, the father of the child at any time during the period beginning with the conception of the child and ending with the birth of the child; and I was not living with the father of the child as a de facto partner at any time during that period, and none of the exceptions below apply. Exceptions to statement 1: The mother and father jointly registered the birth on or after 1 July 2005 on SmartStart or by completing and signing the Notification of birth for registration form (BDM27). • The father’s particulars were included in the child’s birth information on or after 1 July 2005 but no later than 24 January 2009. • A testamentary guardian of the child has been appointed by the deceased parent under section 26(2) of the Care of Children Act 2004 or section 7(2) of the Guardianship Act 1968. • The Court has appointed any other person(s) a guardian. (Yes or no) ^ Statement 2: I, as the child’s mother, am the sole guardian because the child was born as a result of an assisted reproduction procedure (such as donor insemination) to me acting alone, and the donor is not my partner (i.e. not in a marriage, civil union or de facto relationship), and the donor did not become my partner between conception and notification of the birth for registration. (Yes or no) ^ Statement 3: The Family Court has given consent for me to act alone. (Yes or no) ^ If you answered yes to statement 3, attach a copy of the Family Court order (not a Parenting order, previously known as a Custody order). Statement 4: The guardian is unable to act because of a medical condition or they are of unsound mind. (Yes or no) ^ If you answered yes to statement 4, provide evidence from a registered medical practitioner. Statement 5: The guardian(s) is/are dead. (Yes or no) ^ If they died in New Zealand, enter the deceased’s name, date of death and place of death. If they died overseas, include a certified true copy (or original) of the deceased’s death certificate. Deceased guardian’s full name ^ Date of death (dd/mm/yyyy) ^ Place of death (dd/mm/yyyy) ^ Second deceased guardian’s full name ^ Date of death (dd/mm/yyyy) ^ Place of death (dd/mm/yyyy) ^ Statement 6: The guardian(s) is/are missing. (Yes or no) ^ State the recent actions within the last 2 months that you have taken to contact the other guardian(s) and include the date you tried to contact them. This includes searching the electoral roles, the Internet, asking family and friends or former employers. You must also state that you and all the people that know the guardian (which you have contacted) have no way of contacting them below. I/we searched the electoral roles on this date: Date (dd/mm/yyyy) ^ I/we asked friends on this date: Date (dd/mm/yyyy) ^ I/we searched the Internet on this date: Date (dd/mm/yyyy) ^ I/we asked their employers on this date: Date (dd/mm/yyyy) ^ I/we asked family members on this date: Date (dd/mm/yyyy) ^ I/we and all people who known the guardian(s), who I/we have contacted, have no way of contacting the guardian(s). (Yes or no) ^ If you could not attempt to contact the guardian with one of the above methods, attach a letter of explanation. 7. Guardian 1’s full name, occupation, and residential address Guardian 1’s full name ^ Guardian 1’s residential address: Street number and name ^ Suburb ^ Town or city ^ Country ^ Enter your occupation. For example, ‘Landscape gardener’ or ‘Home-maker’. If you have no occupation, enter ‘No occupation’. Guardian 1’s occupation ^ 8. Guardian 2’s full name, occupation, and residential address Guardian 2’s full name ^ Guardian 2’s residential address: Same as Guardian 1’s address (Yes or no) ^ If you answered no, provide Guardian 2’s residential address: Street number and name ^ Suburb ^ Town or city ^ Country ^ Enter your occupation. For example, ‘Landscape gardener’ or ‘Home-maker’. If you have no occupation, enter ‘No occupation’. Guardian 2’s occupation ^ 9. The name I/we want to register for my/our child is: (Refer to ‘Guidelines for your child’s new name’ above.) All first and middle names ^ Surname ^ 10. I/we advise that my/our child intends to use their new name once their name is registered (Yes or no) ^ Is your child is already using their new name? (Yes or no) ^ All guardians need to sign this statutory declaration. Guardian 1 should fill out section 11 in front of the authorised person. Guardian 2 should fill out section 13 in front of the authorised person (if applicable). 11. Guardian 1 must fill out and sign this section before a person authorised to take a statutory declaration (Refer to ‘Statutory declaration requirements’ above for the list of authorised people.) I solemnly and sincerely declare that the information herein in this statutory declaration is accurate and complete and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957 Declared at (Town or city, and country) ^ this day of (dd/mm/yyyy) ^ by (Signature of applicant) ^ 12. The person authorised to take a statutory declaration must complete this section I am satisfied of the applicant’s identity because (select one): I have sighted the applicant’s original photo identification document from the list under ‘Your current photo identification’ (write document name and number below). (Yes or no) ^ Document name (e.g. New Zealand passport) ^ Document number (e.g. Passport number) ^ I have sighted the applicant’s photo on a fully completed BDM76 Identity Referee form. (Yes or no) ^ Signature (Authorised person signs here) ^ Full name of authorised person ^ Qualification of authorised person ^ 13. Guardian 2 must fill out and sign this section before a person authorised to take a statutory declaration (Refer to ‘Statutory declaration requirements’ above for the list of authorised people.) I solemnly and sincerely declare that the information herein in this statutory declaration is accurate and complete and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957 Declared at (Town or city, and country) ^ this day of (dd/mm/yyyy) ^ by (Signature of applicant) ^ 14. The person authorised to take a statutory declaration must complete this section I am satisfied of the applicant’s identity because (select one): I have sighted the applicant’s original photo identification document from the list under ‘Your current photo identification’ (write document name and number below). (Yes or no) ^ Document name (e.g. New Zealand passport) ^ Document number (e.g. Passport number) ^ I have sighted the applicant’s photo on a fully completed BDM76 Identity Referee form. (Yes or no) ^ Signature (Authorised person signs here) ^ Full name of authorised person ^ Qualification of authorised person ^ 15. Human Assisted Reproductive Technology Register (HART) Is your child born as a result of a HART procedure? (Yes or no) ^ If you answered yes, fill in this section. If you answered no, go to Section 16. This section applies if your child was born as a result of an assisted reproductive technology procedure using donated sperm, eggs or embryos through a fertility clinic. If the information has been provided to Births, Deaths and Marriages for inclusion on the HART Register, it will be updated to include your child’s new name. This means that up-to-date information will be provided to persons who are authorised to access your child’s information under the Human Assisted Reproductive Technology Act 2004. Donation made after 21 August 2004 If your child’s birth occured as a result of a donation made after 21 August 2004, information will be sent to a fertility clinic. We can send information about the name change to the fertility clinic. They can then update their records. Yes, I consent to my child’s new name being sent to the fertility clinic named below that holds the information: (Yes or no) ^ If you answered yes, provide fertility clinic name ^ 16. Fees The application fee to register a name change is $170. If your child’s birth is registered in New Zealand, you can also order a birth certificate that shows their new name. If your child’s birth is registered outside New Zealand, you can also order a name change certificate that shows their new name. 17. Birth certificate (additional fee) You can order a birth certificate if: • your child’s birth is registered in New Zealand, and • you need a certificate that shows your child’s new name. There are several types and packages of birth certificate that you can select from. Standard certificate. The standard certificate will be sent folded with the delivery address printed on the back. $33 each. (Enter quantity) ^ Forest style decorative certificate. $35 each. (Enter quantity) ^ Beach style decorative certificate. $35 each. (Enter quantity) ^ Two certificate package: beach style decorative and standard. $55 per package. (Enter quantity) ^ Two certificate package: forest style decorative and standard. $55 per package. (Enter quantity) ^ 18. Name change certificate (additional fee) You can order a name change certificate if: • your child’s birth is registered outside New Zealand, and • you need a certificate that shows your child’s new name. If you do not need a certificate to prove your new name, this is optional. Name change certificate. $33 each. (Enter quantity) ^ 19. Delivery of birth or name change certificate (if applicable) If you have ordered a certificate, select a delivery method: I want the certificate(s) sent by standard post which costs $0. (Yes or no) ^ I want the certificate(s) couriered to a New Zealand address for $5. (Yes or no) ^ I want the certificate(s) couriered to an overseas address for $15 to $30. (Yes or no) ^ Australia, Asia, Pacific courier costs $15. USA courier costs $20. Europe (unless listed under ‘Rest of world’) courier costs $25. Rest of world (includes Azerbaijan, Armenia, Bulgaria, Bosnia and Herzegovina, Cyprus, Croatia, Greece, Georgia, Macedonia, Malta, Moldova) courier costs $30. Contact us if you are unsure whether we can deliver to your country. Delivery address: Delivery name ^ Street number and name ^ Suburb ^ Town or city ^ Country ^ Postcode ^ Complete the payment section. Privacy statement The information provided on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 2021 (the ‘BDMRR’ Act). A person who makes, or causes to be made, a false declaration on this form will be liable on conviction to a fine or term of imprisonment, or both. The new information will be held on a public register, and may generally be accessed by any person on application (e.g. as a certificate or printout). The Department of Internal Affairs may also release it to certain government agencies and foreign registration authorities, as authorised by law. This form, the accompanying certificate, and the details relating to your sex at birth will not be publicly available, except where the Registrar-General is satisfied the information is required in relation to the administration of an estate or trust, a marriage, or by order of a Court. A new birth registration will be made from the information provided. Corrections may be made as provided for in the BDMRR Act. The BDMRR Act governs access to registered information. Information about your rights to access and, where appropriate, correct the information is available on our website govt.nz/bdm or freephone 0800 22 52 52. Fees statement All fees are correct as at the form version date. All fees are in New Zealand dollars. 20. Payment Do not post cash or card. Do not email credit card details. Charge my credit or debit card (Visa, MasterCard, American Express, Prezzy Card): Card number ^ Card expiry date (mm/yy) ^ Name on card ^ Cardholder's signature ^ Next steps Print and sign the form. Post the form, appropriate fee(s), and documents to us. New Zealand office: Births, Deaths and Marriages Department of Internal Affairs PO Box 10-526 Wellington 6140 New Zealand Sydney office: Births, Deaths and Marriages Department of Internal Affairs GPO Box 365 Sydney New South Wales 2001 Australia London office: Births, Deaths and Marriages Department of Internal Affairs 1 Pall Mall East London SW1Y 5AU United Kingdom