*** 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 BDM27 Notification of birth for registration of child born in New Zealand He whakaaturanga o te rēhita whānautanga o te tamaiti i whānau i Aotearoa Last updated 30 January 2025 Use smartstart.services.govt.nz to register the birth online. You will need to use this paper form if only one parent is able to sign. Part 1: Before you apply Why register? Every birth in New Zealand must be registered by law. You should register the birth of your child within 2 months. With some exceptions, both parents must jointly register the birth. Birth registration is the first official step that confirms your child is a New Zealand citizen. It’s free to register your baby, but there’s a charge if you want to order a birth certificate. You will not be sent any confirmation that the birth has been registered unless you purchase a birth certificate (see the order form later in this form). How to register a birth You may register the birth online at smartstart.services.govt.nz or use this form. Take care filling out this form. If you make a mistake you may need to pay for a new birth certificate to be issued, if you order one. Name change fees will also apply. Answer all questions in the form truthfully. It is against the law to give false information. Postage instructions Once you have printed and signed the form, post it to us with the appropriate fee(s), and documents. Postal address Birth Registrations Births, Deaths and Marriages PO Box 10-526 Wellington 6140 Fees and entitlements statement: All fees and entitlements are correct as at the form version date. All fees are in New Zealand dollars. Timeframe To view our current timeframes, go to: govt.nz/bdmtimeframes. If you have ordered a certificate, it will be sent by post or courier. Allow extra time for postage. Contact details Website: govt.nz/bdm/contactus Email: bdm.nz@dia.govt.nz Only use email for queries about the form. Do not email the completed form to us. What you can name your child Your child must be registered with a surname or last name, and 1 or more given names – unless you have religious or cultural reasons to give your child only 1 name. In these cases, please use the ‘-’ symbol to replace the name that you will not use (i.e. first name or surname), and explain why in section 56. Your child’s name will not be accepted if it’s spelled with numbers or symbols (for example, V8). Your child’s name may not be accepted if it’s: • offensive • longer than 70 characters • an official title or rank (for example, Justice). You can still submit a name that falls into 1 of these categories. We assess all names on a case-by-case basis and take your reasoning into account. If your child’s name is acceptable for registration, it will be registered exactly as entered in this form. Fees will apply if you decide to change or alter your child’s name. Their previous name will appear on their birth certificate. Citizenship or residency of parents From 2006, a child born in New Zealand is a New Zealand citizen at birth only if at least one parent is: • a New Zealand citizen • entitled under the Immigration Act 2009 to be in New Zealand indefinitely (i.e. you have a residency visa, residency permit or permanent residency), or • entitled to reside indefinitely in the Cook Islands, Niue or Tokelau. Questions 20 and 33 will ask you if you were a New Zealand citizen, New Zealand permanent resident or Australian citizen or permanent resident, when your child was born. Your details will be checked against databases held by the Citizenship Office, the Ministry of Business, Innovation and Employment (Immigration), and/or with registration authorities in the Cook Islands, Niue or Tokelau (where relevant). Please tick the relevant boxes and provide the necessary information about each parent’s citizenship or immigration status. If you are a New Zealand citizen by descent We will need to confirm whether you are a New Zealand citizen by descent if you: • were born overseas to New Zealand citizen parent(s), or • you were born overseas and adopted by New Zealand citizen parent(s). If your citizenship by descent has been recorded with the Citizenship Office, state the date of your registration/confirmation and citizenship certificate number. If you have not applied for registration or confirmation, contact us using the details below for further information. Further information If you are unsure about your citizenship status: • try our citizenship tool: govt.nz/check-if-you-are-a-citizen • or contact the Citizenship Office: Freephone 0800 22 51 51. If you are unsure about your immigration status, contact the Ministry of Business, Innovation and Employment Immigration): • within New Zealand but outside of Auckland: Freephone 0508 558 855 • from Auckland: 09 914 4100 • outside of New Zealand: +64 9 914 4100. Privacy statement Information regarding the registration of your child’s birth is collected under the Births, Deaths, Marriages, and Relationships Registration Act 2021 (’the Act’). Both parents are primarily responsible for notifying the birth as soon as practicable. It is an offence, punishable by a fine, to fail or refuse to provide information for the registration of a birth. The citizenship or immigration details of the parent(s) of a child born on or after 1 January 2006 will be checked against databases held by the Department of Internal Affairs (Citizenship Office, Passports Office or Births, Deaths and Marriages), the Ministry of Business, Innovation and Employment (Immigration) and/or with registration authorities in the Cook Islands, Niue or Tokelau (where relevant). The information will be used to confirm whether your child is a New Zealand citizen by birth. If you decide to use this form to also apply for an IRD number and/or Best Start for your child, Births, Deaths, and Marriages will give the information you have provided on this form to Inland Revenue for this purpose. After giving the information to Inland Revenue, Births, Deaths and Marriages will not retain details of your IRD number if you have provided it on this form. If you have decided to notify the Ministry of Social Development (MSD) of your child’s birth, Births, Deaths and Marriages will provide MSD with information about the birth when the registration is complete. MSD will use this information to determine how your new baby changes the benefits and services you are entitled to. After giving the information to MSD, Births Deaths and Marriages will not retain details of your MSD client number if you provided it on this form. The birth information collected on this form will be held on a public register. The Act governs access to registered birth information. Information about a named individual may generally be accessed by any person upon application (e.g. as a certificate or printout). Information may be released for statistical, or genuine health or demographic research in the public interest, or to certain government agencies, as authorised by law. Information about why the information is collected, the government agencies that are authorised to receive the information, and about a person’s right to access and, where appropriate, correct the information, is available on our website govt.nz/bdm, or Freephone 0800 22 52 52. Part 2: The form Instructions: • You can complete this form by hand or on-screen using Adobe Reader. • You can use the Tab key to move to the next fillable form field in Adobe Reader. • You must still print off the application and sign where applicable by hand. • The first character of each word must be a capital letter, except where the first letter is lower case. The remainder of each word must be in lower case. e.g. John Wellington, or Te Marama o te Po. • Leave a space between names or words. • When you see this icon (an image of a hand), it means you need to take extra care with your answers. • You must fill in all the questions in this form unless the question says it’s optional. Please read the ‘Before you apply’ section (part 1) of this application form carefully before you start. If your application is not correct and complete, your application may be delayed or unsuccessful. Form begins Tamaiti Child 1. All first or given name(s) of child Enter the child’s first name(s) and any middle names. The child’s names will appear on the birth certificate in the order that you enter them here. Refer to the “Guidelines for your baby’s name” on part 1. Given names ^ 2. Surname or family name of child Surname ^ Office use only: Batch Registration number 3. Child’s sex Female, male, or indeterminate? ^ Indeterminate means your doctor or midwife could not determine the sex of your baby. 4. Was the child alive at birth? Yes or no, the child was stillborn ^ What is a stillbirth? A baby is stillborn if the baby was not alive when born, and: • weighed 400g or more at birth, or • was born after the 20th complete week of pregnancy. You still need to register the birth. If you don’t want to give the baby a first name, you can choose to leave that field blank by adding a dash (-) into the field. What about a miscarriage? A pregnancy is termed a miscarriage if the baby is not born alive, is born before the 21st week of the pregnancy, and weighed less than 400 grams. You don’t have to register the baby if you have suffered a miscarriage. 5. Is this child one of multiple births of twins, triplets, etc? Yes or no ^ If yes, fill out this section. If no, go to section 6. What was the birth order for this child? Enter the birth order number of the child, followed by the number of children in the multiple birth e.g. if the child was the second twin born write ‘2 of 2’. You need to fill out a separate form for each child. Birth order ^ 6. Child’s date of birth Date (dd/mm/yyyy) ^ 7. Where was the child born? Hospital, home birth, or other ^ If hospital, fill out section 7a If home birth, fill out section 7b If other, fill out section section 7c 7a. Child born at hospital Hospital name and town ^ 7b. Child born at home Street number and name ^ Suburb ^ Town or city ^ Postcode ^ 7c. Child born at other location Describe where the child was born. For example, ‘In Transit Corner 338 High Street And Raroa Road Lower Hutt’. Place you gave birth ^ 8. Is this child the descendant of a New Zealand Māori? This information is for statistical purposes and will not be printed on the birth certificate. Yes, no, or not sure ^ 9. What ethnic group or groups does this child belong to? Describe the child’s ethnicity. This information helps other government agencies to get a clearer picture of our society so that health, education and other needs in your area can be planned for. Mark yes to as many options as you’d like to describe your child’s ethnicity. NZ European ^ Cook Islands Māori ^ Chinese ^ Māori ^ Tongan ^ Indian ^ Samoan ^ Niuean ^ Other (please specify) ^ Whaea Parent 1 Complete this section with the details of the person that gave birth to the child. Select parent title (Mother, Father or Parent) ^ 10. All first name(s) parent 1 is currently known by Enter their current first and middle names. If the names were different at birth, you can enter them at section 12. Current first name(s) ^ 11. Surname parent 1 is currently known by Enter all current surnames or family names. If the names were different at birth, you can enter them at section 13. Current surname ^ 12. All first name(s) of parent 1 at birth You only need to complete this section if the parent’s first names at birth are different from their current names (as above). If they were adopted, enter the names given after adoption. First names(s) at birth ^ 3. Surname of parent 1 at birth You only need to complete this section if the parent’s surname at birth is different to their current name. If they are using a married name, enter their birth surname here. If they were adopted, enter the surname given after adoption. Surname at birth ^ 14. Occupation Usual occupation, profession or job of parent 1. Enter the occupation or job title e.g. Engineer. You don’t need to include the name of the employer. If the parent isn’t currently employed, you can enter something like ‘mother’ or ‘unemployed’. Occupation ^ 15. Date of birth of parent 1 Date (dd/mm/yyyy) ^ 16. Place of birth of parent 1 Town or city ^ Country (if not New Zealand) ^ 17. Home address of parent 1 Street number and name ^ Suburb ^ Town/city or locality ^ Postcode ^ Country (if not New Zealand) ^ 18. Is parent 1 the descendant of a New Zealand Maori? (tick one) This information will not be printed on the birth certificate. Yes, no, or not sure ^ 19. What ethnic group or groups does parent 1 belong to? Mark yes to as many options as you wish to describe the ethnic group(s) you belong to. NZ European ^ Cook Islands Māori ^ Chinese ^ Māori ^ Tongan ^ Indian ^ Samoan ^ Niuean ^ Other (please specify) ^ 20. Citizenship or residency of parent 1 Refer to the guide notes in part 1 for further information. Is parent 1 a New Zealand citizen? Yes or no ^ If yes, fill out section 20a If no, fill out section 20b 20a. Parent 1 is a New Zealand citizen Please indicate how the mother is a New Zealand citizen: Born in New Zealand, New Zealand citizen by descent or grant, born in Niue, the Cook Islands, or Tokelau ^ If you were born in Niue, the Cook islands, or Tokelau, enter your New Zealand passport or citizenship number. New Zealand passport number ^ 20b. Parent 1 is not a New Zealand citizen Please indicate how the mother is entitled to reside in New Zealand: New Zealand permanent resident (includes resident visa or permit), Resident of the Cook Islands, Niue, or Tokelau, Australian citizen or permanent resident of Australia, or none of the above ^ If you are a resident of the Cook Islands, Niue, or Tokelau, or you are an Australian citizen/permanent resident of Australia, enter the passport or travel document number you entered New Zealand on below Passport or travel document number ^ 21. Parent 1's contact details We will use these contact details if we have queries with this form. Please include phone number area code or suffix, but don’t use brackets or spaces. Daytime contact phone number ^ Alternative contact number ^ Email address ^ Matua Parent 2 This section is where you give the details of the child’s other parent (if known). If you don’t know who the other parent is you must still register the child. Is the other parent known? Yes or no ^ If yes, enter the other parent's details. If no, go to question 35. Select parent title (Mother, Father or Parent) ^ 22. Is the child born as a result of an assisted human reproduction procedure? E.g. using IVF or a sperm donor Yes or no ^ If yes, read the information below. If no, go to question 23. If a child was born as a result of an assisted human reproduction procedure (such as artificial insemination), the details in questions 23 to 34 should be completed as follows: a. if the parent who gave birth married, or entered into a civil union or de facto relationship with, a man who consented to the parent who gave birth undergoing the procedure, that man’s details should be entered. The donor is generally not the father or other parent. b. if the parent who gave birth married or entered into a civil union or de facto relationship with a woman who consented to the parent who gave birth undergoing the procedure, tick the following box, enter the details of the partner, and complete the details in the rest of the form wherever details of “Parent 2” are indicated. 23. All first name(s) parent 2 is currently known by Enter all current first and middle names. If the names were different at birth, you can enter them at question 25. Current first name(s) ^ 24. Surname parent 2 is currently known by Enter all current surnames or family names. If the names were different at birth, you can enter them at question 26. Current surname ^ 25. All first name(s) of parent 2 at birth You only need to complete this section if the parent's first names at birth are different from their current names (as above). If parent 2 was adopted, enter the names given after adoption. First names(s) at birth ^ 26. Surname of parent2 2 at birth You only need to complete this section if the parent's surname at birth is different to their current name. If the parent was adopted, enter the surname given after adoption. Surname at birth ^ 27. Occupation Usual occupation, profession or job of parent 2. Enter the occupation or job title e.g. Engineer. You don’t need to include the name of the employer. If the parent isn’t currently employed, you can enter something like ‘father’ or ‘unemployed’. Occupation ^ 28. Date of birth of parent 2 Date (dd/mm/yyyy) ^ 29. Place of birth of parent 2 Town or city ^ Country (if born outside NZ) ^ 30. Home address of parent 2 Street number and name ^ Suburb ^ Town/city or locality ^ Postcode ^ Country (if not NZ) ^ 31. Is Parent 2 the descendant of a New Zealand Māori? This information will not be printed on the birth certificate. Yes, no, or not sure ^ 32. What ethnic group or groups does parent 2 belong to? Mark yes to as many options as you wish to describe the ethnic group(s) you belong to. NZ European ^ Cook Islands Māori ^ Chinese ^ Māori ^ Tongan ^ Indian ^ Samoan ^ Niuean ^ Other (please specify) ^ 33. Citizenship or residency of Parent 2 Is the father/other parent a New Zealand citizen? Yes or no ^ If yes, fill out section 33a. If no, fill out section 33b. 33a. Parent 2 is a New Zealand citizen Please indicate how the father is a New Zealand citizen: Born in New Zealand, New Zealand citizen by descent or grant, born in Niue, the Cook Islands, or Tokelau ^ If you were born in Niue, the Cook islands, or Tokelau, enter your New Zealand passport or citizenship number. New Zealand passport number ^ 33b. Parent 2 is not a New Zealand citizen Please indicate how the father is entitled to reside in New Zealand: New Zealand permanent resident (includes resident visa or permit), Resident of the Cook Islands, Niue, or Tokelau, Australian citizen or permanent resident of Australia, or none of the above ^ If you are a resident of the Cook Islands, Niue, or Tokelau, or you are an Australian citizen/permanent resident of Australia, enter the passport or travel document number you entered New Zealand on below Passport or travel document number ^ 34. Parent 2's contact details We will use these contact details if we have queries with this form. Include phone number area code or suffix. Daytime contact phone number ^ Alternative contact number ^ Email address ^ Hononga mātua Parents’ relationship This section is where you give information on the relationship of the parents, including other children from the same relationship. 35. Are there other children born from the same parent relationship? This means previous children born to the same parents. Yes or no ^ If yes, fill out this section. If no, go to question 36. Complete the following table giving the sex and date of birth for each child. Do not include the child you are registering now. Table begins Row 1, headings: Column 1: Child, Column 2: Sex (Male (M), female (F), non-binary (N), or indeterminate(I)), Column 3: Is this child alive, where they stillborn, or have they since died?, Column 4: Date of birth (dd/mm/yyyy) Row 2: Column 1: Child 1, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 3: Column 1: Child 2, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 4: Column 1: Child 3, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 5: Column 1: Child 4, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 6: Column 1: Child 5, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 7: Column 1: Child 6, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 8: Column 1: Child 7, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 9: Column 1: Child 8, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Row 10: Column 1: Child 9, Column 2: M ^ F ^ N ^ I ^ , Column 3: Alive ^ Stillborn ^ Has since died ^ , Column 4: DOB ^ Table ends 36. What was the parents’ relationship with each other at the time of the child’s birth? Not married or in a civil union or de facto relationship, in a de facto relationship, married, in a civil union ^ If married or in a civil union, enter date and place of ceremony below Date of ceremony (dd/mm/yyyy) ^ Place of ceremony (city/town and country) ^ Not every relationship where two people live together (and aren’t married, or in a civil union) is a de facto relationship under the law. Being considered to be in a de facto relationship depends on a number of things, including: • the couple’s circumstances, including their ages • the length of their relationship • how committed the couple are to a sharing a life together, and • how public they make their relationship to friends and family. It’s important that you know whether or not you are in a de facto relationship before you select the de facto relationship option. If you’re unsure you should get advice from a lawyer. Apply for Best Start payments If you’re a New Zealand resident you can get Best Start payments until your baby turns 1, no matter what you earn. Receiving Best Start payments won’t affect any other payments or benefits you get. However, if you or your partner are a new or returning resident, and currently have a temporary tax exemption of foreign sourced income, you will need to be aware that by applying for Best Start (which is part of Working for Families), you and your partner will be automatically opted out of the temporary tax exemption. For more information about temporary tax exemption, see: www.ird.govt.nz/roles/nz-tax-residents/exemption Best Start is a government payment of $73 a week for each child born on or after 1 July 2018. You can apply now, but your Best Start payments usually won’t start until Paid Parental Leave finishes. More about Best Start payments Best Start payments are part of the Working for Families. An IRD number will be created for your child if you choose to get Best Start payments. When your baby turns one, Best Start payments become income-tested. You may continue to get payments depending on your family’s income. If your family’s income is: • under $79,000 a year before tax, you will continue to get $69 a week until your child turns 3 • between $79,000 - $97,276 a year before tax, you may continue to get payments at a reduced amount until your child turns 3 • over $97,276 a year before tax, you will stop getting payments for your child after they turn 1. 37. Do you want to apply for Best Start now? Yes or no ^ If yes, fill out section 38. If no, go to section 49. 38. Who is the child’s principal caregiver? (required) Best Start payments are made to the principal caregiver of the child you are registering. What is a principal caregiver? Parent 1, Parent 2, other, unknown ^ A principal caregiver must be at least 16 years old and is the person responsible for the day to day care of the child on a permanent basis. Someone caring for a child on a temporary basis, such as in a childcare centre, is not a principal caregiver. If Parent 1, go to section 38a. If Parent 2, go to section 38a. If other, fill in section 38b, then go to section 49. If unknown, go to section 49. 38a. Parent’s IRD number IRD number ^ 38b. Other principal caregiver’s details (Inland Revenue will use these to contact the principal caregiver) First and middle names ^ Surname ^ Daytime phone number ^ 39. Does the principal caregiver receive a benefit from the Ministry of Social Development (MSD)? Yes or no ^ If yes, go to section 49. 40. Does the principal caregiver currently receive Working for Families payments from Inland Revenue? Yes or no ^ If yes, an IRD number will be issued to this child, go to section 49. Working for Families payments (which include the Best Start payment) can only be made to New Zealand tax residents. You are a tax resident in New Zealand if you: • are in New Zealand for more than 183 days in any 12-month period and haven’t become a non-resident, or • have a ‘permanent place of abode’ in New Zealand, or • are away from New Zealand in the service of the New Zealand government. 41. Will the child be a resident and living in New Zealand when the principal caregiver is receiving Best Start payments? Yes or no ^ If yes, go to section 44. 42. Has the principal caregiver lived in New Zealand continuously for at least 12 months at any time? Yes or no ^ If no, go to section 49. 43. Will the principal caregiver be a tax resident when receiving Best Start payments? Yes or no ^ If no, go to section 49. 44. . Does this child live with someone else for more than 2 days a week (shared care)? Shared care is when you share the care of a child with another person who lives in a different household. In a shared care situation there may be more than one principal caregiver eligible for Best Start payments. For more information about shared care, go to ird.govt.nz/working-for-families/shared-care. Indicate the answer that applies: Yes or no ^ If yes, provide the other carer's contact details below for IRD. Other carer’s first and middle names ^ Other carer’s surname ^ Other carer’s daytime phone number ^ 45. Does the principal caregiver have a spouse or partner living with them? Yes or no ^ If yes, provide spouse or partner’s contact details below for IRD Spouse’s first and middle names ^ Spouse’s surname ^ 46. Is the principal caregiver taking Paid Parental Leave (PPL) for this child? Best Start payments will start when Paid Parental Leave finishes. Yes or no ^ 47. How often do you want the Best Start payments to be made? You can choose to have your Best Start payments: • Weekly - up to $73 per week • Fortnightly - up to $146 per fortnight • Yearly (lump sum) – up to $3,838 paid after the end of the tax year Weekly, fortnightly, or yearly ^ 48. Principal caregiver’s bank account (required) This must be in the principal caregiver’s name or held jointly with their spouse or partner. Bank account number ^ Bank account holder’s name ^ Credit union reference (if applicable) ^ Application for your child’s IRD number If you apply for your child’s IRD number, Births, Deaths and Marriages will provide birth registration information to Inland Revenue. They will create your child’s IRD number and help protect it from misuse. If you have any questions about requesting an IRD number: • go to ird.govt.nz/about-this-site/privacy/privacy-policy.html for more on how information is used and protected • go to ird.govt.nz/how-to/irdnumbers/individuals/ for more information about applying for an IRD number, or • phone Inland Revenue on 0800 775 247 and use keyword “newborn IRD number”. The easiest way for you to get an IRD number for your child is by using this birth registration form. It is free to apply for an IRD number and it saves you having to get another set of forms to apply for it later. To apply for your child’s IRD number using this form, one of the parents needs to: • be a New Zealand or Australian citizen • have New Zealand or Australian permanent residency, or • be a resident of the Cook Islands, Tokelau, or Niue. You will need an IRD number for your child if you want to include this child in current Working for Family payments (which includes Best Start payments) or you are opening a KiwiSaver account or bank account in your child’s name. If you apply for an IRD number for your child, you should receive it 25 working days after submitting a correct and complete birth registration form. The IRD number will arrive separately to your child’s birth certificate, if you have requested one. 49. Do you want to apply for an IRD number for this child? Yes or No ^ If yes, fill in the rest of this section. If no, go to section 53. Select ‘Yes’ if you have applied for Best Start payments. In order for you to receive Best Start payments, Inland Revenue need to issue an IRD number for your child. Best Start payments will start when Paid Parental Leave finishes. 50. Please choose an address Inland Revenue should post your child’s IRD number to: Parent 1's address from section 17, Paarent 2's address from section 30, or the birth certificate address from section 58 (if you order one) ^ 51. Do you also wish to receive your child’s IRD number by email? By selecting ‘Yes’ you agree to receive your child’s IRD number by email. Inland Revenue will take all reasonable steps to reduce any risk of unauthorised access or release of confidential information. If you don’t provide consent, your child’s IRD number will be mailed to the postal address you have provided. Yes or No ^ 52. Your IRD number Provide your IRD number if: • you already receive Working for Families payments from IRD, or • you have applied for Best Start payments with your child’s birth registration. Inland Revenue will include your child’s IRD number in your Working for Families record. Best Start is part of Working for Families. Your IRD number ^ Notify the Ministry of Social Development (MSD) of the birth If you are an existing Ministry of Social Development (MSD) client you should notify MSD to determine how having your new baby changes your benefits and services. You can choose to have Births, Deaths and Marriages notify MSD when the birth is registered. MSD will then contact you as quickly as possible to discuss how your benefits and services will change. This means you do not need to provide a birth certificate to MSD and may not need to visit an MSD office. For more information on what MSD does with your personal information, go to: workandincome.govt.nz/about-this-site/privacy-disclaimer-and-copyright-information.html 53. Do you give permission for Births, Deaths and Marriages to notify the Ministry of Social Development of the birth of your child? (Choose one) I am not an existing MSD client, no I do not give permission, yes I do give permission ^ If you are not an existing MSD client, go to the ‘Signatures’ section before section 54. If you do give permission, provide the MSD client number of one or both parents below. Parent 1’s MSD client number ^ Parent 2’s MSD client number ^ Disclaimer The Ministry of Social Development (MSD) will use the birth of child information that you agreed to provide to MSD to determine eligibility to payments and or services. MSD may need to contact you and/or ask for further verification to help them determine this. The Ministry of Social Development includes Work and Income, MSD Housing Assessment, Senior Services, StudyLink and other service lines. The legislation administered by the Ministry of Social Development allows MSD to check the information that you provide. This may happen when you apply for assistance and at any time after that. Signatures Both parents must sign the form unless one of 4 situations listed below apply. 1. One parent is: • Dead • Unknown • Missing • Of unsound mind, or • Unable to act because of a medical condition. 2. Requiring the other parent to sign the form would cause unwarranted distress to either of the parents. 3. The other parent is overseas and it is not possible to obtain their signature within a reasonable period of time. Please note: this exception only applies to overseas where there is no delivery address or contact details. 4. The child is born as a result of a woman acting alone in an assisted human reproduction procedure and the donor of the ovum, embryo, or semen (as the case may be) for the pregnancy does not become the partner of the woman after the time of conception but before the birth is notified for registration. The donor is generally not the father or other parent. If you are not sure what details to enter contact us (contact details at the beginning of this form). When only one parent signs If any of the above circumstances apply, the details of both parents must be entered on the form. Exceptions apply when: • the other parent is unknown, or • the child was born as a result of the parent who gave birth acting alone in an assisted human reproduction procedure. If one parent has not signed and their details are entered on this form, if able, you should provide evidence that the other person named is the biological mother/father. That evidence may be a Paternity Order, a Court Declaration, DNA Test Results or statutory declarations from family members. 54. Sign and date I declare that the information entered on this form is true and correct: Signature of parent 1 ^ Date signed ^ I declare that the information entered on this form is true and correct: Signature of Parent 2 ^ Date signed ^ 55. If only one parent has signed, indicate which option applies: A. One parent is deceased. If they died in New Zealand provide the date of death in the ‘Other information’ section below. If they died outside New Zealand, attach a copy of the death certificate (with an English translation where necessary) to this form. B. One parent is missing. State in the ‘Other information’ section below what steps you have taken to contact the other parent. Include whether or not you have contacted the other parents’ friends and family or used social media to locate and contact the other parent. C. One parent is unsound of mind. Provide evidence from a registered medical doctor and attach it to this form. D. One parent is unable to sign the form because of a medical condition. Provide evidence from a registered medical doctor and attach it to this form. E. Requiring the other parent to sign the form would cause unwarranted distress to either of the parents. State the nature of the parental circumstances in the ‘Other information’ section below. F. The other parent is overseas and it is not possible to obtain their signature within a reasonable period of time. This exception only applies to overseas where there is no delivery address or contact details. Please state the circumstances in the ‘Other information’ section below. G. The child is born as a result of a woman acting alone in an assisted human reproduction procedure and the donor of the ovum, embryo, or semen (as the case may be) for the pregnancy does not become the partner of the woman after the time of conception but before the birth is notified for registration. Provide evidence from a registered medical doctor or from a fertility clinic and attach it to this form. Which of A, B, C, D, E, F, or G applies? ^ 56. Other information you want to advise us (continue on a separate sheet if necessary) ^ If you do not want to order a birth certificate for your child, this form is complete. If you wish to order a birth certificate for your child, complete sections 57–59. Birth certificate Ordering a birth certificate is optional. You do not need to purchase a birth certificate if you only require a birth certificate to verify the birth with MSD. 57. Type of birth certificate There are several types and packages of birth certificates that you can select from. Enter quantity: Standard certificate (The certificate will be sent folded with the delivery address printed on the back) $33 ^ Forest style decorative certificate $35 ^ Beach style decorative certificate $35 ^ Two certificate package: beach style decorative and standard $55 ^ Two certificate package: forest style decorative and standard $55 ^ 58. Birth certificate delivery Select a delivery method: I want the certificate(s) sent by standard post $0 (checkbox) ^ I want the certificate(s) couriered to a New Zealand address $5 (checkbox) ^ I want the certificate(s) couriered to an overseas address $15 - $30 (checkbox) ^ Australia, Asia, Pacific: $15 USA: $20 Europe $25 Rest of world: $30 Includes: Azerbaijan, Armenia, Bulgaria, Bosnia and Herzegovina, Cyprus, Croatia, Greece, Georgia, Macedonia, Malta, Moldova Contact us if you are unsure whether we can deliver to your country. Contact information is in part 1. Delivery address: Delivery name ^ Street number and name ^ Suburb ^ Town or city ^ Country ^ Postcode ^ Complete the payment section in section 16 of the form. 59. Payment Do not post cash or card. Do not email credit card details. Charge my debit or credit card (Visa, MasterCard, American Express, Prezzy Card): Card number ^ Card expiry date ^ Name on card ^ Cardholder signature ^ Form end