*** 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.
Nomination of Marriage Celebrant by Approved Organisation – Declaration. 

This statutory declaration can only be submitted with your online application. 

We, the under-signed being members of (and 18 years of age or older) the organisation known as
Organisation name ^
do hereby request that the name of
Marriage Celebrant’s full name ^
an adult member of the organisation, be placed on the List of Marriage Celebrants pursuant to the Marriage Act 1955. 

Chief Office Bearer, if appointed
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

Full names of ten members aged 18 or over (the Chief Office Bearer cannot also sign this part)

1.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

2.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

3.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

4.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

5.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

6.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

7.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

8.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

9.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

10.
Full name ^
Signature ^
Age ^
Full residential address including town/city ^

Form of declaration - The declaration below must not be made by the marriage celebrant nor any other persons who have signed above.

Statutory Declaration

I, 
Your full name ^
of 
Enter the address where you live ^
Occupation 
Enter your occupation for example, bricklayer, teacher, unemployed ^

verify the signatures as the genuine signatures of the persons whose signatures they purport to be, and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957. 

Note: Do not complete the following section until you are with the person witnessing your declaration.They must be a Justice of the Peace, solicitor, Registrar of Marriages or another person authorised to take a statutory declaration.

Your signature ^
Declared at 
Enter place - for example town or city ^
DD/MM/YYYY ^

Before me
Name of official witness ^
Signature of official witness ^