*** 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 451 Request for Pre-Adoptive New Zealand Birth Certificate. Tono Tiwhikete Whānau o Aotearoa i Mua i te Whāngaitanga When a person has been legally adopted in New Zealand, the birth certificate normally issued is the post-adoptive birth certificate, showing the details of the adoptive parents. If you are born in New Zealand and adopted in New Zealand, and are 20 years of age or older, you may complete this form to request a copy of your original, pre-adoptive birth certificate, showing the details of your birth before you were adopted. Your pre-adoptive, original, birth certificate is issued in accordance with the Adult Adoption Information Act (“AAI Act”) 1985, and will be stamped “Issued for the Purposes of the Adult Adoption Information Act 1985”. Who may request a pre-adoptive birth certificate. Only the adopted person may request their pre-adoptive birth certifi cate (once 20 years of age or older). Parent may not wish their information be given to adoptee. If you were adopted before 1 March 1986, either of your original birth parents may request that their identifying information not be given to you. Each such request expires after 10 years unless earlier removed or reinstated on request of that parent. Counselling. The process by which your request is managed depends on the date you were adopted - we will not know this until after we have received your request. The process will be either of: Adopted before 1 March 1986. If you were adopted before 1 March 1986 you must first receive counselling from a social worker or approved person or organisation (unless you are living overseas). Births, Deaths and Marriages will post your pre-adoptive birth certificate and contact details to your chosen counsellor and they will give you your certificate. Adopted on or after 1 March 1986. If you were adopted on or after 1 March 1986 we will offer you counselling, but you may ask that the pre-adoptive birth certificate be sent directly to you if you do not desire counselling. As required by the AAI Act 1985, if you do not require counselling we will post you a letter advising you that we are holding your pre-adoptive birth certificate on your behalf, and another letter requesting you confirm your decision not to have counselling. Overseas delivery If you were adopted before 1 March 1986, you can have your birth certificate sent to your overseas address. If you were adopted after 28 February 1986: • tick that you want your certificate sent to your overseas address in Part E; • after we receive your application, we will write to you telling you the certificate is held on your behalf; • you will need to respond to our letter confirming that you do not want counselling. List of social workers, approved persons or organisations (i.e. counsellor). The list of approved counsellors is included below. Alternatively, you may contact us and we will send you the list. Please phone your chosen counsellor first to make sure they are available to assist you. Contact us. If you have any questions contact us: • Freephone: 0800 22 52 52 (New Zealand only) • Phone: +64 9 339 0852 (from outside New Zealand) • Email bdm.nz@dia.govt.nz Instructions. 1. You must complete two forms. Each may be completed separately but both must be posted to us together: • Request for Pre-adoptive New Zealand Birth Certificate (BDM451) form; and a • General Identity Declaration (BDM130) form. 2. Include the fee for your pre-adoptive birth certificate(s). 3. Post the forms to: Adult Adoption Information Officer. Births, Deaths and Marriages, PO Box 10526, Wellington 6140, New Zealand. Do not fax or scan. • Under section 5, Adult Adoption Information Act 1985, counselling support is required upon the release of a pre-adoptive birth certificate • Following is a list of people who are appointed to provide counselling • Counselling can be face to face or by telephone • Independent Counsellors are people in the community appointed by the Minister of Social Welfare • Oranga Tamariki have a specialised Adoption Service that can also assist with the release of a pre-adoptive birth certificate District: Auckland Tāmaki-makau-rau Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Auckland. Independent counsellors Alison Cleland (Birkenhead) Phone (09) 418 2768 Mobile 0274 399 789 alison.c.cleland@gmail.com Lesley Read (Onehunga) Phone (09) 624 4084 Mobile 022 156 3959 lesley@read.org.nz Patricia Stroud (Hibiscus Coast) Phone (09) 421 1451 District: Bay of Plenty Te Moana-a-Toi Oranga Tamariki Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Rotorua or Tauranga. Independent counsellors. Irene Maxwell Phone (07) 549 3002 Mobile 027 437 1404. Suzanne Harrison 07 886 4786 027 448 2734 suzanneharrison1960@gmail.com District: Canterbury Waitaha Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Christchurch. Independent counsellors. Wendy Philpott Mobile 022 185 3165 wendaphil83@gmail.com Murray Roberts (Christchurch) Mobile 021 244 3224 District: Central Otago/Otago Otākou Oranga Tamariki Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Dunedin Independent counsellors. Catholic Social Services (03) 448 5385 Central Otago Catholic Social Services (03) 455 3838 Dunedin Janet Elder 027 711 2394 Janetsimelder@gmail.com District: East Cape Te Tai Rāwhiti Oranga Tamariki Adoption Service 0508 326 459 (0508 FAMILY) 027 285 3019 District: Hawke's Bay Te Matau-a-Māui Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) 027 285 3019 Ask to speak to the adoption social worker in Napier. District: Manawatū-Whanganui Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) 027 285 3019 Ask to speak to the adoption social worker in Whanganui or Palmerston North Independent counsellors Chris Thomas 027 280 7325 projectteamltd@gmail.com District: Northland Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Auckland. Independent counsellors Colin Edwards (09) 436 3561 021 436 356 c.medwards@actrix.co.nz District:Southland Oranga Tamariki Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Invercargill. District: Tasman Te tai-o-Aorere Nelson Whakatū Marlborough Te Tauihu-o-te-waka Oranaga Tamariki Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Nelson District:Taranaki Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) 027 285 3019 Ask to speak to the adoption social worker in Whanganui. District: Waikato Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) 027 328 1300 Ask to speak to the adoption social worker in Hamilton. Independent counsellors. Corinne Young Phone (07) 856 9517 Mobile 021 905 659 corinne@wanion.net Karen Sloane (Thames) Mobile 022 0929653 minniewku1994@gmail.com District:Wellington and Wairarapa Te Whanga-nui-a-Tara Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) 04 917 1155 027 200 1586 Ask to speak to the adoption social worker in Wellington. Independent counsellors. Robyn Henley (04) 938 7255 027 231 6196 robynhenley61@gmail.com District: West Coast Te Tai Poutini Oranga Tamariki. Adoption Service 0508 326 459 (0508 FAMILY) Ask to speak to the adoption social worker in Christchurch. Independent counsellors. Wendy Philpott Mobile 022 185 3165 wendaphil83@gmail.com Internal Affairs Te Tari Taiwhenua Form BDM 451 Request for Pre-Adoptive New Zealand Birth Certificate. Part A. My Address. Full name (if different from your post-adoptive name). ^ Flat number (if applicable). ^ Street number. ^ Street. ^ Suburb or rural locality. ^ City, town or district. ^ Postcode. ^ Country (if not New Zealand). ^ Part B. My details. Your post-adoptive (current) names and adoptive parents. Post-adoptive (current) Surname. ^ Post-adoptive (current) First names. ^ Place of birth (town or city). ^ Date of birth. (DD/MM/YYYY) ^ Post-adoptive parents details at the time of the adoption. Mother/Father’s surname. ^ Mother/Father’s first names. ^ Father/Mother’s surname. ^ Father/Mother’s first names. ^ Part C. My contact details between 8am and 5pm Monday to Friday (NZ time). Phone number. ^ Phone number (alternative). ^ Email address. ^ Part D. Nominated counsellor. My nominated counsellor is ^ The town or city of the counsellor. ^ Part E. How many certificates and payment details. Certificates cost $15.30 each. Number of certificates. ^ Select a delivery method. Standard delivery is free. Courier is $5. International courier costs between $15 to $30, depending on your location. I want the certificate sent by standard post to my chosen counsellor Yes or No ^ I want the certificate couriered to my chosen counsellor for $5 Yes or No ^ I want the certificate couriered to my overseas address for $15 to $30 Yes or No ^ Do not post cash. Total amount to pay $ ^ Payment. Charge my credit/debit card. VISA Yes or No ^ Mastercard Yes or No ^ Amex Yes or No ^ Prezzy Card Yes or No ^ Card number. ^ Expiry date. (MM/YY) ^ Cardholder's name. ^ Cardholder's signature. ^ Privacy Statement The information on this form is collected under the Adult Adoption Information Act 1985. As part of processing your request, your identification details may be checked against other records held by Births, Deaths and Marriages or other government agencies, as authorised by law. Internal Affairs Te Tari Taiwhenua BDM 130 General Identity Declaration. Reference number. ^ Warning. It is an offence, punishable by imprisonment and/or a fine of up to $10,000, to make a false statement to obtain a certificate, printout or a source document, or to provide any means of identification knowing that it is false or is suspected to be forged or falsified. Instructions. If you have any questions or you are unsure about how to complete this form please contact us: • Within New Zealand. Freephone 0800 22 77 77 • Outside New Zealand. phone +64 9 339 0852 1. The applicant must fully complete both Parts A and B. 2. Part C must be completed by any other person 16 years of age or older. Part A. My Details (as the applicant). Current name. Surname. ^ First names. ^ Name at birth (if different from above) Note: This is not your name before you were adopted, if you know that. Surname at birth (if different from above). ^ First names at birth (if different from above). ^ Place and Date of birth. ^ Place of birth (town or city) including country if not New Zealand. ^ Date of birth. (DD/MM/YYYY) ^ Part B. My declaration (the applicant must complete). I declare that the information about me that is entered on this form is true and correct. Signature. ^ Date signed. (DD/MM/YYYY) ^ If applying on behalf of a company state their name below and include an original signed request on letterhead. ^ Your details or the company name may be entered in the Access Register. For information about the Access Register visit www.bdm.govt.nz Part C. Referee’s declaration (any other person 16 years of age or older must complete). I am 16 years of age or older and have known the applicant for at least 6 months or have seen a government issued photo identification of the applicant and I am satisfied the information about the applicant’s identity stated in this form is true and correct. Signature of referee. ^ Date signed. (DD/MM/YYYY) ^ Full name of referee. ^ Phone number of referee. ^ Contact address of referee. ^ Privacy Statement The information on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 1995. As part of processing your request, your identification details will be checked against other records held by Births, Deaths and Marriages or other government agencies, as authorised by law. Version 03 February 2023