*** 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. *** 
Internal Affairs Te Tari Taiwhenua

Application for Appointment as an Independent Marriage Celebrant and/or Civil Union Celebrant.
Good character.

Two referees are required. 

Applicants personal details.

Full current name ^
Full name at birth, if different from above ^
Date of birth (Date Month Year, for example 1 January 1950) ^
Place of birth ^
Country of birth (if not NZ) ^

A person (other than a family member) over the age of 16 years of age must complete and sign below.

I (full name) ^
Have known the applicant for ^ years and declare that they are a person of good character.

I fully support their application to be an independent celebrant. 
Years and declare that they are a person of good character.

Signature ^
Date signed ^

Daytime phone number or email address ^