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Internal Affairs Te Tari Taiwhenua

BDM405

Authorisation for Disclosure of Information to Agent.


I authorise the Registrar-General of Births, Deaths and Marriages to disclose any information to which I am entitled from the Human Assisted Reproductive Technology Register to: 
Full name of "Agent". ^

Signature of donor. ^
Printed full name of donor. ^

or

Signature of donor offspring or guardian. ^
Printed full name of donor offspring or guardian. ^

Today's date. (DD/MM/YYYY) ^

Post to: HART Team, Births, Deaths & Marriages (HART), PO Box 10526, Wellington 6143.