*** 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 BDM159 (Declaration) Nomination of Marriage Celebrant by Approved Organisation – Declaration Last updated 07 December 2018 This statutory declaration can only be submitted with your online application The marriage celebrant must notsign any part of this declaration 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 ^ on Enter date (DD/MM/YYYY) ^ Before me Name of official witness ^ Signature of official witness ^