*** 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. 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 6143, New Zealand. Do not fax or scan. Counsellors appointed to provide counselling by the Adult Adoption Information Act 1985. Following is a list of counsellors who are appointed to provide counselling as required by the Adult Adoption Information Act 1985. • Counselling can be face to face or by telephone. Please state your preference when making the appointment. • Independent Counsellors are people in the community appointed by the Minister of Social Development because of their personal involvement in the adoption process. As they are mostly voluntary workers, please check their availability prior to nominating them. It is not necessary to check in advance with counsellors from Oranga Tamariki. District: Auckland Child, Youth and Family. Senior Practitioner Social Worker Adoption Services Phone (09) 914 1112 Auckland Region. Independent counsellors Alison Cleland Phone (09) 418 2768 Birkenhead. Lesley Read Phone (09) 624 4084 Onehunga. Patricia Stroud Phone (09) 424 1035 Hibiscus Coast. District: Alexandra Child, Youth and Family. Social Worker Adoption Services Phone 03 901 6674 Alexandra. District: Blenheim and Nelson Independent counsellors. Anne Knight Phone (03) 577 7717 Blenheim. Child, Youth and Family. Supervisor Adoption Services Phone (03) 989 4202 Nelson. Independent counsellors. Lynne Barron Phone (03) 539 1006 Nelson. District: Christchurch/West Coast Child, Youth and Family. Supervisor Adoption Services Phone (03) 961 5605 Christchurch Region. Independent counsellors. Wendy Philpott Phone (03) 980 7914 Christchurch. Murray Roberts Phone 021 244 3224 Christchurch. District: Dunedin/Otago Child, Youth and Family. Supervisor Adoption Services Phone (03) 955 3438 Dunedin. Independent counsellors. Catholic Social Services Phone (03) 455 3838 Dunedin. Janet Elder Phone 027 711 2394 Macandrew Bay. District: Gisborne Child, Youth and Family. Supervisor Adoption Services Phone (06) 986 4182 Gisborne. Rob Dalziell Phone (06) 837 8622 Nuhaka. District: Hamilton Child, Youth and Family. Supervisor Adoption Services Phone (07) 957 4722 Hamilton. Corinne Young Phone (07) 856 9517 Hamilton. District: Horowhenua and Manawatu Social Worker Phone (06) 952 0262 or 029 770 1192 Horowhenua and Manawatu District: Invercargill Child, Youth and Family. Supervisor Adoption Services Phone (03) 948 4427 Invercargill. District: Levin Child, Youth and Family. Supervisor Adoption Services Phone (06) 949 4230 Levin. District: Masterton Child, Youth and Family. Social Worker Adoption Services Phone (04) 917 1155 Masterton District: Napier Child, Youth and Family. Social Worker Phone (06) 974 4326 Napier. Independent counsellors. Janet Milner Phone (06) 835 3684 Napier. District: Palmerston North Child, Youth and Family. Supervisor Adoption Services Phone (06) 952 0204 Palmerston North. Independent counsellors. Christine Mary Thomas Phone 027 280 7325 Palmerston North District: Rotorua/Tauranga Child, Youth and Family. Supervisor Adoption Services Phone (07) 921 5030 Rotorua. Independent counsellors. Suzanne Harrison Phone (07) 357 5330 after hours or 027 293 5942 Rotorua. Irene Maxwell Phone (07) 549 3002 Katikati. District: Thames Independent counsellors. Karen Sloane Phone (07) 863 9253 Thames. District: Timaru Child, Youth and Family. Social Worker Adoption Services Phone (03) 956 4484 Timaru. Independent counsellors. Cena Moulson Phone (03) 927 2624 or 027 432 9287. District: Tauranga Child, Youth and Family. Supervisor Adoption Services Phone (07) 928 5100 Tauranga District: Whanganui, Taranaki and Taumarunui Child, Youth and Family. Social Worker Adoption Services Phone (06) 965 3467 Wanganui. District: Wellington Child, Youth and Family. Supervisor Adoption Services Phone (04) 917 1145 or (04) 917 1155 Wellington Region. Independent counsellors. Christine Mary Thomas [Not currently available] Phone 027 280 7325 Wellington. Robyn Henley (04) 938 7255 027 231 6196 Wellington. District: Whangarei Child, Youth and Family. Social Worker Adoption Services Phone (09) 983 5009 Whangarei. Independent counsellors. Colin Edwards Phone (09) 436 3561 or 021 436 356 Whangarei. 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. ^ 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. Last updated 18 February 2020.