*** 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 BDM 120 Application to register a Name Change. For a person: • aged 18 or older, or • under 18 and are, or have been, married, in a civil union or de facto relationship. He tono ki te rehita i tetahi Panoni Ingoa - Mo tetahi tangata 18 tau, neke atu ranei, kei raro ranei i te 18 tau, i marena, hono a-ture, moe maori ranei. Who may register a name change? To register a name change in New Zealand: • Your birth must be registered in New Zealand; or • If your birth is registered outside New Zealand, you must be a New Zealand citizen or entitled, under the Immigration Act 2009, to be in New Zealand indefinitely (e.g. as a permanent resident). Guidelines about the new name. What must the name consist of? Your new name must consist of one surname and one or more other names, unless your religious or philosophical beliefs, or cultural traditions require you to bear only one name - in which case attach a letter of explanation. What is not acceptable? Your new name (or combination of names) may not be accepted for registration if: • it might cause offence to a reasonable person; or • it is unreasonably long (that is, it should be less than 100 characters long, including spaces); or • without adequate justification, it is, includes, or resembles, an official title or rank (in which case attach a letter of explanation); or • it is not a name (for example, it must not consist of or include numbers or symbols). You must make true statements . You must make true statements when completing this application. 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. How much time should I allow for this? Applications will be processed in 15 working days, from receiving a correct and complete application (plus postage time). If you have requested with your application a Birth Certificate or Name Change Certificate showing your new name, it will issued as soon as the name change is processed. Certificate showing your new name. Birth registered in New Zealand. If your birth is registered in New Zealand, any new birth certificate that is issued will show the new name as well as all previous names. A new birth certificate can be made available after registration, on payment of an additional fee. Birth registered outside New Zealand. If your birth is registered outside New Zealand, any new name change certificate that is issued will show the new name as well as all previous names registered in New Zealand on or after 25 January 2009. A new name change certificate can be made available after registration, on payment of an additional fee. Contact Details. Births, Deaths, Marriages, Citizenship, Authentications and Translations: • Website www.govt.nz/bdm • Freephone 0800 22 52 52 (New Zealand only). If overseas phone (+64 9) 339 0852 • Email bdm.nz@dia.govt.nz Documents to attach. Contact us if you cannot meet these requirements. If your birth is registered in New Zealand you must provide documents from List 2 and 3 (below). If your birth is registered overseas you must provide documents from List 1, 2 and 3 (below). Include an official English translation of any document that is not in the English language. List 1. Your eligibility to apply to register a name change in New Zealand. If your birth is registered in New Zealand go directly to List 2 below (as you are eligible to apply to register a name change). If your birth is registered outside New Zealand you must provide evidence of the date and place of your birth, and of your status as a New Zealand citizen or person who is entitled, under the Immigration Act 2009, to be in New Zealand indefinitely. Provide a certified true copy of one (or combination if applicable) of the following current documents: New Zealand Citizenship Certificate New Zealand Passport (a certified copy of the page with your photo on it is sufficient) New Zealand Certificate of Identity issued under the Passports Act 1992 with a letter/permit/visa from Immigration New Zealand confirming permanent residence status. Australian Passport or some other evidence of Australian citizenship Cook Islands, Niue or Tokelau Birth Certificate Overseas Passport including a residence permit or resident visa issued by Immigration New Zealand Letter from Immigration New Zealand confirming permanent residence status (if the letter states your name, date and place of birth) Overseas Birth Certificate together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status Notarial Certificate (China) together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status Household / Family Census Register from an Asian country together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status. List 2. Your current photo identification. You must provide a certified true copy of one of the following 8 identification documents, which includes your photo (If you are providing a document from List 1 that has your photo on it go directly to List 3). New Zealand or overseas Passport (a certified copy of the page with your photo on it is sufficient). New Zealand or International Driver Licence. 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. You must also present your current photo identification to the person authorised to take a statutory declaration at the time that you sign the declaration below of the form. That person may also be able to certify your documents at the same time. List 3. Proof of the use of your identity in the community. You must provide copies of two documents from different sources, for example: Utility accounts (including gas, water, electricity, mobile or home phone). Bank statements (including savings, credit or cheque accounts). Lease or tenancy agreements. Rates notices. Inland Revenue Tax Number (provide an IR card or statement). Electoral Roll Record. Motor vehicle registration. Student or tertiary identity card. Educational certificate or school report. Trade certificate. Certificate of approval or licence issued by the Private Security Personnel Licensing Authority. Steps to Freedom form. Confirmation of Permit Status from Immigration. You must sign before one of these people. The persons authorised to take statutory declarations depends on the country in which you are signing this form. Qualification of person authorised to take a statutory declaration: In New Zealand. • Registrar of Births, Deaths and Marriages • Justice of the Peace • Notary Public • Person enrolled as a barrister and solicitor of the High Court • Registrar or a Deputy Registrar of the Supreme Court, Court of Appeal, High Court or a District Court • Some other person authorised by law to administer an oath In a 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 the law of that country to administer an oath for the purpose of a judicial proceeding. Refer below for examples In a country other than a Commonwealth country. • Commonwealth representative • Notary Public • Judge • Solicitor of the High Court of New Zealand The list of authorised persons is provided below at the place where you sign the declaration. The following is provided if you are signing this form in Australia which is a'Commonwealth countries other than New Zealand'. 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. Persons authorised to take statutory declarations in all of Australia. • Judge. • Notary Public. • Justice of the Peace. • Solicitor of the High Court of New Zealand. • Australian legal practitioner. • Court clerk or registrar who certifies his or her 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: • vCommissioner for Oaths (by personal appointment). • Member of the Legislative Assembly. • Member of house of the Parliament of the Commonwealth elected to represent the Territory or a constituency in the Territory. • Member of the Police Force who has attained the age of 18 years. Also, if in Queensland: • Commissioner for Declarations. • Conveyancer. The following is provided if you are signing this form in the United Kingdom, which is a'Commonwealth countries other than New Zealand'. Persons authorised to take statutory declarations in England or Wales. • Judge. • Commissioner 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 his or her authority to take an oath for a judicial proceeding. • Commonwealth representative. Persons authorised to take statutory declarations in Ireland or Northern Ireland. • Judge. • Solicitor. • Notary Public. • Justice of the Peace. • Court clerk or registrar who certifies his or her authority to take an oath for a judicial proceeding. • Commonwealth representative. • Solicitor of the High Court of New Zealand. Persons authorised to take statutory declarations in Scotland. • Judge. • Notary Public. • Justice of the Peace. • Person authorised by the law of that country to administer an oath for the purpose of a judicial proceeding. • Commonwealth representative. • Solicitor of the High Court of New Zealand. Privacy statement. The information provided on this application is collected under the Births, Deaths, Marriages, and Relationships Registration Act 1995 (the “BDMRR Act). The 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 Births, Deaths, Marriages, Citizenship, Authentications and Translations office may also release it to certain government agencies and foreign registration authorities, as authorised by law. 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 www.govt.nz/bdm or Freephone 0800 22 52 52. Post the form, appropriate fee(s), and evidence as applicable, to one of: New Zealand Name Change Team Births, Deaths and Marriages Department of Internal Affairs PO Box 10-526 Wellington 6143 New Zealand Sydney Births, Deaths and Marriages Department of Internal Affairs GPO Box 365 Sydney New South Wales 2001 Australia London Births, Deaths and Marriages Department of Internal Affairs New Zealand House 80 Haymarket London SW1Y 4TQ United Kingdom Internal Affairs Te Tari Taiwhenua BDM 120 Form begins. Application to register a Name Change. For a person: aged 18 or older, or under 18 and are, or have been, married, in a civil union or de facto relationship. He tono ki te rehita i tetahi Panoni Ingoa - Mo tetahi tangata 18 tau, neke atu ranei, kei raro ranei i te 18 tau, i marena, hono a-ture, moe maori ranei. Important. Please read the Notes (above) of this application form carefully before you start. You may experience delays or your application may be unsuccessful if it is not correct and complete. Complete and Return all pages. Part 1. Information we need to process your application. 1. Old name. My name at birth is - if legally adopted then enter the names you were given after the adoption. All first names at birth ^ Surname at birth ^ My name only if I have previously registered or deposited a name change in New Zealand or overseas. The name below is the name you are changing from, if it is different from your name at birth. It is not a surname you have assumed e.g. on marriage or civil union. All first names of most recently registered or deposited name change ^ Surname of most recently registered or deposited name change ^ 2. My date of birth. Date of birth (DD/MM/YYYY) ^ 3. My place of birth. Town or City of birth ^ Country of birth (if not New Zealand) ^ Refer to Lists 1, 2 and 3 of the notes above at the start of this application. If your birth is registered in New Zealand: I have attached documents from List 2 and 3. Yes or No ^ If your birth is registered outside New Zealand: I have attached documents from List 1, 2 and 3. Yes or No ^ 4. Your contact details, if we have questions about this application. Best phone number ^ Email ^ 5. I want the original evidence I provide with this application: Only provide certified true copies of original evidence. Return it to me. Yes or No ^ Destroy it. Yes or No ^ Important. Take care completing this statutory declaration as you may be required to do it again if there are errors. Part 2. Statutory Declaration to Register a Name Change. 6. I Full current name ^ 7. of (this is your residential address - this is not a PO Box) Flat number (if applicable) ^ Street number ^ Street ^ Suburb or rural locality ^ City, town or district ^ Postcode ^ Country (if not New Zealand) ^ 8. a enter your occupation ^ (if no occupation print ‘no occupation’) solemnly and sincerely declare that: I authorise any necessary additional enquiries including the disclosure of personal information about myself for the purpose of determining eligibility for this name change application. My authorisation includes, but is not limited to, any information held by the Service Delivery and Operations branch, Department of Internal Affairs. If I submit an application for New Zealand citizenship or a New Zealand passport at the same time as this application is submitted, I authorise any necessary additional enquiries including the disclosure of personal information about myself so both applications can be processed. Important. Read the notes below if you are married or in a civil union. Assumed surname. Generally, you do not need to register your assumed surname on marriage or civil union as organisations may acknowledge your new surname using some other evidence, such as your marriage certificate. Only changing your first names. If you are married or in a civil union and only want to change your first names, print the surname of your new name below as it is currently recorded on your birth registration (i.e. do not print a surname you assumed on marriage). 9. If 16 or 17 years of age, I am or have been in a: Civil Union Yes or No ^ Marriage Yes or No ^ De facto relationship Yes or No ^ Date of marriage/civil union (DD/MM/YYYY) ^ Place of marriage/civil union ^ Important. All corrections must be initialled, dated by yourself then witnessed by a person authorised to take a statutory declaration. 10. My old legal name was formally registered in: New Zealand Yes or No ^ Outside New Zealand Yes or No ^ 11. My new name is (refer to the “Guidelines for the new name”) All first and middle names ^ Surname of your new name ^ 12. I advise that: I am already using my new name, or Yes or No ^ I intend to use my new name in the future Yes or No ^ Only sign below when before a person authorised to take a statutory declaration. 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 (if not New Zealand) ^ this day of (DD/MM/YYYY) ^ by Signature of declarant ^ The person authorised to take a statutory declaration must complete the section below. I am satisfied of the declarant's identity by sighting his or her original photo identification document (from List 2 of the notes above). The document I relied on was: Document name (e.g. New Zealand Passport) ^ Document number (e.g. passport number) ^ Complete all following details and select one qualification from the list of 17 below. Before me Signature of authorised person ^ Authorised person's full name ^ Authorised person's ID number (e.g. JP #) ^ Part 3. Fees and Payment details. Do Not Post Cash. Application fee to register a name change: $170.00 If a certificate is required to show the new name. If your birth is registered in New Zealand you can get a Birth Certificate. Standard certificates have a plain white background and no additional images. There are two types of decorative certificates available. The forest decorative certificate shows a stream surrounded by native bush, including koru, fern and kowhai. The beach decorative certificate shows a woman sitting with a baby on a beach. The women looks out towards the sea as her family waves back at her. Please indicate the number you need for each certificate design. Standard and Forest. Two certificate package $55.00 Quantity wanted? ^ Standard and Beach. Two certificate package $55.00 Quantity wanted? ^ Forest. $35.00 each. Quantity wanted? ^ Beach. $35.00 each. Quantity wanted? ^ Standard. $33.00 each. Quantity wanted? ^ For a limited time only: All Blacks theme NZ Birth Certificate Standard and All Blacks. Two certificate package $55.00 Quantity wanted? ^ All Blacks. $35.00 each. Quantity wanted? ^ If your birth is not registered in New Zealand, you can get a Name Change Certificate (only if your birth is registered overseas) for $35.00 each. Quanity of Name Change Certificates ^ Certificate fee (optional) total from above ^ Courier fee is $5.00 if to be delivered within New Zealand. If you wish to courier to an overseas address contact us for details Courier fee (optional) ^ Total amount to pay ^ If paying in person at one of our offices in Auckland, Manukau, Wellington or Christchurch we also accept EFTPOS and cash payments. I choose the following method to pay: I have enclosed a New Zealand cheque or International bank draft in NZ dollars made out to the Department of Internal Affairs. Note: Australian money orders can only be receipted at the Sydney office. Yes or No ^ or Charge my credit card. Yes or No ^ Visa Yes or No ^ Mastercard Yes or No ^ AMEX Yes or No ^ (a) Card Number. ^ (b) Expiry Date. (MM/YY) ^ (c) Cardholder's name. ^ (d) Cardholder's signature. ^ Delivery Address if ordering a certificate and it is not to be posted to your residential address. Delivery name ^ Flat number (if applicable) ^ Street number ^ Street ^ City, town or district ^ Postcode ^ Country (if not New Zealand) ^ Important. Only complete and return this next section if it applies to you. Including your new names on your New Zealand marriage or civil union record. The first few pages of this application are to register a name change on your birth record (if registered in New Zealand) or name change record (if your birth is registered overseas). Once registered, you may order a certificate as evidence of your new name - usually this is all you need to do. For an extra fee of $55.00 (plus an optional $33.00 for a marriage/civil union certificate), and if you are currently married or in a civil union and your marriage or civil union is registered in New Zealand, you may, if you wish, choose to have your new names added to your marriage or civil union record. I have included the additional fee of $55.00 and request that my new name be recorded on my New Zealand registered marriage or civil union. Yes or No ^ Optional: I have included an additional $33.00 for a marriage or civil union certificate to be issued after my new name is recorded on my New Zealand registered marriage or civil union. Yes or No ^ If yes to the above, answer the following for your most recent New Zealand marriage or civil union. Marriage Yes or No ^ Civil Union Yes or No ^ Date of marriage/civil union (DD/MM/YYYY) ^ Place of marriage/civil union in New Zealand ^ Human Assisted Reproductive Technology (HART) Register. This section only applies to people who have provided information to Births, Deaths and Marriages for inclusion on the HART Register. If you are either a donor or you were born as a result of an assisted reproductive technology procedure, information about you held by Births, Deaths and Marriages on the HART Register can be updated to include your new name. This means that up-to-date information will be provided to persons who are authorised to access your information under the Human Assisted Reproductive Technology Act 2004. Are you a donor or person born as a result of a HART procedure whose details are recorded on the HART Register? Yes or No ^ If you donated an egg/sperm/embryo after 21 August 2005, information about you will also be held by the fertility clinic. We can send information about your name change to the fertility clinic, so that the clinic’s records can be updated. Yes. I consent to my new names being sent to the fertility clinic named below that holds information about me. ^ Fertility clinic name. ^ This page is optional. Once completed, obtain all signatures, scan along with any attachments and email to ISBDMMaintenanceTeam@dia.govt.nz Last updated 11 January 2019.