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Internal Affairs Te Tari Taiwhenua

BDM93N


Tono Tiwhikete Huri Ingoa Tangata o Aotearoa
Request for New Zealand Name Change Certificate

A Name Change Certificate is only available if the subject was born overseas and they registered a name change in NZ after 25 January 2009

Order certificates online at www.govt.nz/bdm

If the subject’s birth is registered in NZ you need to request a birth certificate (form BDM93B).

If you intend to use the certificate overseas refer to www.govt.nz/authentications

Section 1: Certificate details

Surname (required) ^ 
First and middle names (required)
Surname at birth (if different from above) ^ 
First and middle names at birth (if different from above) ^ 
Date of birth (required) ^ 
Town or city of birth (include country if not NZ) ^ 
Year of name change (if known) ^
Other information (e.g. RG or registration number) ^ 

Section 2: Delivery and contact details
 
Delivery name ^
Flat no ^
Street no ^
Street name ^
Suburb or rural locality ^
City, town or district ^
Postcode ^
Country (if not New Zealand) ^ 
Applicant's contact phone number ^
Applicant's email address ^

Section 3: Certificate style and quantity

Select the certificates you want, and write the quantity you want of each. The certificate will be sent folded with the delivery address printed on the back. 

Name change certificate $33.00 Quantity ^

Section 4: Payment

I want the certificate(s) couriered to a New Zealand address $5.00 Yes or No ^
I want the certificate(s) couriered to an overseas address Australia, Asia, Pacific $15; USA $20; Europe $25; Rest of the world $30 Yes or No ^

Select how you will pay
Do not post cash

Visa Yes or No ^
Mastercard Yes or No ^
American Express Yes or No ^
Prezzy card Yes or No ^
Do not post us your prezzy card

Card number ^
Expiry date ^ 
Card verification value ^
Name on card ^
Cardholder signature ^ 

Section 5: Proof of identity

We check your details in this form against another identity record

Choose one of the following to confirm your identity

I was born in New Zealand Yes or No ^
I was married or entered into a civil union in New Zealand Yes or No ^
Date of marriage or civil union ^
Town or city of marriage or civil union ^ 
My child was born in New Zealand Yes or No ^
Child's date of birth ^
Child's full name ^ 

OR include a photocopy of one of the following identity documents. Do not send the original: Yes or No ^
- Passport (NZ or overseas) 
- Drivers licence (NZ or overseas) 
- 18+ Card (issued by Hospitality NZ)
- NZ Firearms or Dealer’s Licences 
- Salvation Army identity certification 
- NZ Refugee Travel Document
- NZ Emergency Travel Document
- NZ Certificate of Identity (Issued by Immigration NZ) 
- NZ Certificate of Identity (Issued under the Passport Act 1992) 
- Steps to Freedom document (issued by Department of Corrections)

Section 6: Declaration

My first and middle names ^  
My surname ^  
My first and middle names at birth (if different) ^  
My surname at birth (if different) ^  
My date of birth ^  
My town or city of birth, and country if not NZ ^   

I am ordering on behalf of a company, and have included a signed request on company letterhead Yes or No ^  

I declare that the information above is true and correct. I understand that any person who makes a false statement will be liable on conviction to a fine or imprisonment, or both. I understand the information on this form is collected under the Births, Deaths, civil unions, and Relationships Registration Act 2021. As part of processing my request, 
I understand that my identification details will be checked against other records held by the Department of Internal Affairsor other government agencies, as authorised by law. I understand that my name will be recorded on the access register for any non-historical certificates that I order.

My signature ^   
Date signed ^  
 
Submit your form and payment by mail or in person. 

By mail

Certificate Team
Births, Deaths and civil unions
PO Box 10526
Wellington 6140
New Zealand

In person

Visit www.govt.nz/bdmoffices for the location of offices in Auckland, Manukau, Wellington, Christchurch, Sydney and London.
 
Office Use Only B D

Last updated 24 October 2023