*** 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 BDM359 Panui mo tetahi hononga a-ture e marohitia ana He huringa o te piringa mai i te marena Notice of Intended Civil Union Change of relationship from marriage Notice number Sign this application in person before a Registrar of Civil Unions and post it with fee to BDM Licence Application, Department of Internal Affairs, PO Box 10526, Wellington 6143. What you need to know • You need to arrange your licence more than 3 working days before your civil union. It expires after 3 months. • Only one of you needs to complete the application, but you need information about both of you. • It costs $150 for a civil union licence or $240 for a registry civil union. • One of the parties must sign the application personally before a Registrar of Civil Unions and make the required statutory declaration. • You may be required to provide evidence of the dissolution of the most recent marriage or civil union of each of the parties, if any. • You must complete all applicable fields. When you need to use a paper form • Entering a civil union, or • Changing your civil union to a marriage, or vice versa, or • Aged 16 or 17 years old, or • Giving notice in NZ to get married in the United Kingdom. For more information refer to www.govt.nz/bdm. Take care completing this statutory declaration as you may be required to do it again if there are errors. SECTION 1: Notice details Date or approximate date of civil union (Within the next 3 months) ^ Full address of place you will have your civil union ^ Alternative address of civil union e.g. wet weather alternative (If applicable) ^ Full name of Civil Union Celebrant ^ SECTION 2: Parties to civil union Details for party 1. Current first or given name(s) ^ Current surname or family name ^ First or given name(s) at birth (if different from above) ^ Surname or family name at birth (if different from above) ^ Sex ^ Full date of birth (DD/MM/YYYY) ^ If you are aged 16 or 17 attach a consent from a Family Court Judge Place of birth (town/city, and country if not New Zealand) ^ Usual occupation, profession or job ^ Usual residential address in full ^ Include flat number (if applicable). Street number and name. Suburb or rural locality. City, town or district. Country (if not New Zealand). Daytime phone number ^ Contact email address ^ Parents. Legal parents. Parties must include the details of their legal parents. If including details about same-sex parents, those must be the details of the party's adoptive parents, or the person's mother and her female spouse or partner where the circumstance in paragraph (b) of the following section ("Other parent") applies. Other parent If a child was born as a result of an assisted human reproduction procedure (such as artificial insemination): a. If the mother married, or entered into a civil union or de facto relationship with a man who consented to the mother undergoing the procedure, that man's details should be entered as the Father. b. If the mother married, or entered into a civil union or de facto relationship with a woman who consented to the mother undergoing the procedure, the mother's partners details can be entered as either Mother or Other parent, as per her preference. Details of first parent. Mother Yes or No ^ Father Yes or No ^ Current first or given name(s) ^ Current surname or family name ^ Surname or family name at birth (if different from above) ^ Details of second parent. Father Yes or No ^ Mother Yes or No ^ Other parent Yes or No ^ Current first or given name(s) ^ Current surname or family name ^ Surname or family name at birth (if different from above) ^ *If you are aged 16 or 17 attach a consent from a Family Court Judge Details for party 1. Current first or given name(s) ^ Current surname or family name ^ First or given name(s) at birth (if different from above) ^ Surname or family name at birth (if different from above) ^ Sex ^ Full date of birth (DD/MM/YYYY) ^ If you are aged 16 or 17 attach a consent from a Family Court Judge Place of birth (town/city, and country if not New Zealand) ^ Usual occupation, profession or job ^ Usual residential address in full ^ Include flat number (if applicable). Street number and name. Suburb or rural locality. City, town or district. Country (if not New Zealand). Daytime phone number ^ Contact email address ^ Parents. Legal parents. Parties must include the details of their legal parents. If including details about same-sex parents, those must be the details of the party's adoptive parents, or the person's mother and her female spouse or partner where the circumstance in paragraph (b) of the following section ("Other parent") applies. Other parent If a child was born as a result of an assisted human reproduction procedure (such as artificial insemination): a. If the mother married, or entered into a civil union or de facto relationship with a man who consented to the mother undergoing the procedure, that man's details should be entered as the Father. b. If the mother married, or entered into a civil union or de facto relationship with a woman who consented to the mother undergoing the procedure, the mother's partners details can be entered as either Mother or Other parent, as per her preference. Details of first parent. Mother Yes or No ^ Father Yes or No ^ Current first or given name(s) ^ Current surname or family name ^ Surname or family name at birth (if different from above) ^ Details of second parent. Father Yes or No ^ Mother Yes or No ^ Other parent Yes or No ^ Current first or given name(s) ^ Current surname or family name ^ Surname or family name at birth (if different from above) ^ *If you are aged 16 or 17 attach a consent from a Family Court Judge SECTION 3: After your ceremony Where will you and your partner live after your civil union? If you are on the New Zealand Electoral roll, the Electoral Commission will contact you for details of any changes (e.g. your surname) after your civil union. This helps to keep the Electoral roll up to date. Street number and name ^ Suburb ^ Postcode ^ Town/city ^ Country (If not NZ) ^ SECTION 4: Current civil union Place of civil union* (Including country if not in New Zealand) ^ Date of civil union ^ SECTION 5: Statutory declaration To be completed in front of the Registrar (Refer to the list at the end of this form) I solemnly and sincerely declare: (1) that the information provided in this notice is true; and (2) that I believe that the civil union is not prohibited by section 9 of the Civil Union Act 2004*; and (3) that , ^ being under the age of 18 years, the consent required by law to intended civil union have been given; and (4) that there is no lawful impediment to the intended civil union. (5) that the above parties are married to each other and wish to change the form of relationship from a marriage to a civil union. And I make this solemn declaration conscientiously believing the same to be true by virtue of the Oaths and Declarations Act 1957. Declared at. ^ This day of (DD/MM/YYYY) ^ Signature of party giving notice ^ Print full name of party giving notice ^ Signature of Registrar of Civil Unions ^ Print full name of Registrar of Unions ^ * Section 9 and 10 of the Civil Union Act 2004 and Schedule 2 of that Act which set out the prohibited degrees of civil union are printed on later on this form. SECTION 6: Civil Union licence fee and delivery Civil union licence fee and delivery Select ONE box below for each of the options given The type of ceremony you are having is a: $150 civil unionlicence for a personalised ceremony Yes or No ^ (Your celebrant may charge an additional fee. BDM does not set the level of that fee) $150 Registry civil union ceremony - Available from 1 July 2019 Yes or No ^ (You will need to pay an additional $90 directly to your celebrant) Delivery name ^ Street number and name ^ Postcode ^ Town/city ^ Suburb ^ Country (If not NZ) ^ How would you like your civil union licence sent? Note: If you are having a registry ceremony your licence will be sent directly to your celebrant. $5 Courier with New Zealand Yes or No ^ FREE Emailed to this address ^ Civil union certificate fee (optional) Your civil union certificate will be sent to you after your ceremony and the civil union is registered Quantity of civil union certificates required ($33.00 each) ^ Shipment of civil union certificate (select ONE box) $0.00 I want the item(s) sent by standard post Yes or No ^ $5.00 I want the item(s) couriered to a New Zealand address Yes or No ^ $15.00 - $30.00 I want the item(s) couriered to an overseas address Yes or No ^ USA: $20 Australia, Asia, Pacific: $15 Rest of world: $30 Europe: $25 Street number and name ^ Delivery name ^ Postcode ^ Suburb ^ Town/city ^ Country (If not NZ) ^ Payment Do not post cash or card Tick ONE box below to specify your payment method. Please charge my credit card (Visa, MasterCard, American Express, Prezzy) ^ Card number ^ Card expiry date ^ Cardholder signature ^ Name on card ^ Locations to sign this form Auckland Registry Office 12- 14 Nicholls Lane Auckland Manukau Registry Office 7 Ronwood Avenue Manukau Rotorua District Court 1162 Tutanekai Street Rotorua Tauranga District Court 26 McLean Street Tauranga Whakatane District Court 7 Pyne Street Whakatane Gisborne District Court 1 Customhouse Street Gisborne Hastings District Court 106 Eastbourne Street W Hastings Napier District Court 251 Hastings Street Napier Wairoa District Court 106-108 Queen Street Wairoa Dannevirke District Court 5-7 Gordon Street Dannevirke Levin District Court 9 Bristol Street Levin Ohakune (Ruapehu District Council) 59 Huia Street Taumarunui Palmerston North District Court 486 Main Street East Palmerston North Taihape District Court 10 Tui Street Taihape Taumarunui District Court Miriama Street Taumarunui Whanganui District Court Market Place Whanganui Kaikohe District Court Station Road Kaikohe Kaitaia District Court 13 Redan Road Kaitaia Whangarei District Court 105-109 Bank Street Whangarei Hawera District Court 64-68 Princes Street Hawera New Plymouth District Court Robe Street New Plymouth Hamilton District Court 116 Anglesea Street Hamilton Huntly District Court 4-6 Glasgow Street Huntly Matamata Matamata-Piako District Council Corner Tainui and Tui Street Morrinsville District Court 31 Moorehouse Street Morrinsville Taupo District Court Story Place Taupo Te Aroha Matamata-Piako District Council 4-6 Glasgow Street Thames District Court 505 Queen Street Thames Tokoroa District Court Bridge Street Tokoroa Carterton District Council 50 Halloway Street Carterton Masterton District Court Corner Dixon Street and Park Ave Masterton Ashburton District Court Corner of Baring Square West and Cameron Street Ashburton Christchurch Registry Office Level 1 120 Hereford Street Christchurch Timaru District Court 12-14 North Street Timaru Blenheim District Court 58 Alfred Street Blenheim Nelson District Court 200 Bridge Street Nelson Motueka Arthur Woodcock Accountants 121 King Edward Street Alexandra District Court 4-6 Kelman Street Alexandra Dunedin District Court 1 Dunbar Street Dunedin Queenstown District Court 36 Stanley Street Queenstown Gore District Court 6 Hokonui Drive Gore Invercargill District Court 33 Don Street Invercargill Greymouth District Court 60 Guiness Street Greymouth Westport District Court 11 Wakefield Street Westport Chatham Islands Police Station Waitangi-Tuku Road Chatham Islands Information about your intended civil union What are the legal requirements for all civil union ceremonies? The legal requirements are that: · The civil union must be performed by a Civil Union Celebrant at the place(s) specified on the civil union licence; · The civil union must be performed in the presence of at least two witnesses; and · During the ceremony, and before at least two witnesses, each party must make a clear statement that names both parties and acknowledges that they are freely joining in a civil union with each other. · Both parties and witnesses must sign the registration forms (Copy of Particulars of Civil Union) Both parties must sign the registration forms using their pre-civil union signatures according to their names on the Civil Union Licence. For example, if one party is assuming the other’s surname on civil union, that party must sign the registration forms using their usual signature. Children may act as witnesses if they understand the importance of the part they take in the recording of the civil union and can demonstrate that understanding in court if later required to do so. What must the Civil Union Celebrant do at the civil union ceremony? The Civil Union Celebrant must officiate at the civil union ceremony. This includes: · The formal identification of the parties named on the civil union licence (the celebrant must be satisfied that the persons about to be joined are in fact those named on the civil union licence); · The exchange of the civil union statements; · After both copies of the registration papers (Copy of Particulars of Civil Union) have been signed and witnessed, the Civil Union Celebrant must return the Registrars copy to the issuing Registry Office within 10 calendar days - the couple keep the other copy; · The Civil Union Celebrant must take all reasonable steps to ensure the civil union is registered with Births, Deaths and Marriages. Persons other than the Civil Union Celebrant may be involved in the ceremony by, for instance, reading a poem. There should be no doubt in the eyes of the couple, witnesses and attendees that the civil union ceremony was performed by a Civil Union Celebrant. Registry Ceremonies Please be aware if you are considering having a registry ceremony that they are standardised to meet the legislative requirements of entering into a civil union, which includes standard civil union statements. There are limitations on the time the ceremony takes (usually 10 minutes), the space for guests and other persons may not generally be involved in the ceremony. Notes Parents Legal parents: Parties must include the details of their legal parents. If including details about same-sex parents, those must be the details of the party’s adoptive parents, or the person’s mother and her female spouse or partner where the circumstance in paragraph (b) of the following section (“Other parent”) applies. Other parent: If a child was born as a result of an assisted human reproduction procedure (such as artificial insemination): (A) if the mother married, or entered into a civil union or de facto relationship with, a man who consented to the mother undergoing the procedure, that man’s details should be entered as the Father. (B) if the mother married, or entered into a civil union or de facto relationship with a woman who consented to the mother undergoing the procedure, the mother’s partners details can be entered as either Mother or Other parent, as per her preference. Restrictions on civil union Section 9: Partners not to be within prohibited degrees of civil union Two people who are within the prohibited degrees of civil union, as set out in Schedule 2, are prohibited from entering into a civil union with each other, except as provided in section 10. Section 10: Order dispensing with prohibition on civil union within prohibited degrees of affinity (1) Two people who are within the prohibited degrees of affinity, but who are not within the prohibited degrees of consanguinity, may apply to the Family Court for an order under this section. (2) On an application under subsection (1), the court may make an order dispensing with the prohibition in section 9. (3) The Registrar of any court where an order under this section is made must send a copy of the order to the Registrar-General. Schedule 2: Prohibited degrees of civil union (1) Person A and Person B are within the prohibited degrees of a civil union if person A is person B’s- (a) grandparent: (b) parent: (c) child: (d) grandchild: (e) sibling: (f) parent’s sibling: (g) sibling’s child: (h) grandparent’s spouse or civil union partner: (i) parent’s spouse or civil union partner: (j) spouse’s or civil union partner’s parent: (k) spouse’s or civil union partner’s grandparent: (l) spouse’s or civil union partner’s child: (m) child’s spouse or civil union partner: (n) grandchild’s spouse or civil union partner: (o) spouse’s or civil union partner’s grandchild. (2) The prohibited degrees of civil union apply whether the relationships described are by the whole blood or by the half blood. (3) In this schedule, spouse and civil union partner includes a former spouse or former civil union partner, whether alive or deceased, and whether the marriage or civil union was terminated by death, dissolution, or otherwise. For further information Website: www.govt.nz/bdm Email: bdm.nz@dia.govt.nz Call free: 0800 22 52 52 Overseas: (+64 9) 339 0852 Births, Deaths and Marriages PO Box 10526 Wellington 6143 Privacy Statement: The information sought on this form is collected under the Civil Union Act 2004 and is required for a Civil Union Registrar to process the civil union licence application. Failure to complete the form could result in the application being declined. A person who makes, or causes to be made, a false declaration on this form will be liable on conviction to a fine or term of imprisonment, or both. If the civil union takes place, the information contained in this form will be transferred to the civil union registration form (the BDM345s) and form the basis of the registration of the civil union in accordance with the Births, Deaths, Marriages, and Relationships Registration Act 1995 (the “BDMRR Act”). If this information is so registered, it will be held on a public register, and may generally be accessed by any person on application (e.g. as a certificate or printout). Births, Deaths, and Marriages may also release it to certain government agencies, as authorised by law. The Privacy Act 1993 provides rights of access to, and correction of, personal information collected on this form. However, the BDMRR Act governs access to registered civil union information. Information about your rights to access and, where appropriate, correct the information, is available by contacting Births, Deaths and Marriages. Last updated 25 March 2020