*** 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. *** The Department of Internal Affairs Te Tari Taiwhenua DCS CONOTH-B Application for confirmation of birth in New Zealand Includes Cook Islands, Tokelau and Niue. Use this application form if: • you were born in New Zealand before 1 January 2006, or • you were born in New Zealand on or after 1 January 2006, and at least 1 of your parents had the right to reside in New Zealand indefinitely. Please contact the Department of Internal Affairs if you were born outside of these dates, and for information regarding your eligibility for citizenship. How long it takes Please forward your application to the address at the end of the form. It takes 15 working days if we receive a correct and complete application. Allow extra time for delivery to and from the Citizenship Office. How much it costs The processing fee is NZ$112.40 (including GST). Refund policy We are not authorised to issue refunds once the application has been lodged with the Department. The fee is for investigating the claim and does not depend on the outcome. Documents you need with the application You need to include: • the applicant's full Cook Islands, Tokelau or Niue birth certificate, with parents’ details. If you were born in New Zealand you don't need to provide your New Zealand birth certificate • 2 passport-sized photos of the applicant, 1 witnessed on the reverse side by the person who has completed the proof of identity section of the application form • any other documents that show name changes for the applicant such as marriage/civil union certificates or statutory declaration name change. Note: the Department of Internal Affairs does not accept photocopies of documents of any kind. 1. Name Please enter your title, for example Mr, Mrs, Ms, Miss, Master or Other ^ Family/last name ^ First name(s) ^ Other name, for example birth name, unmarried name, name change, alias, English names if used ^ If your name has changed, was it by marriage/civil union, declaration, common use, adoption or for other reasons? Enter reason here ^ If marriage/civil union, what date was the marriage/civil union? ^ 2. Identification Town/ City of birth ^ Country of birth ^ Date of Birth (DD/MM/YYYY) ^ Are you male or female? ^ 3. Parent’s details Mother's title, for example Mrs, Ms, Miss, Other ^ Mother's family/last name ^ Mother's first name ^ Mother's other name, for example birth name, unmarried name, name change, alias, English names if used ^ Father's title, for example Mr, Other ^ Father's family/last name ^ Father's first name ^ Father's other name, for example birth name, unmarried name, name change, alias, English names if used ^ 4. Address and contact details Please note: This is the address that the completed certificate will be sent to. Address details Street ^ Suburb ^ Town/City ^ Province ^ Country ^ Post Code ^ Contact details Home phone ^ Work phone^ Mobile phone ^ Fax ^ Email ^ Privacy Act Authorised information matching programmes Information held by Citizenship can be used in authorised information matching programmes by the Electoral Enrolment Centre, the Department of Internal Affairs, the Inland Revenue Department, the Land Transport New Zealand, the Ministry of Education, the Ministry of Social Development and the Workforce Group (Immigration Services) as authorised by statute. Details are available on the Internal Affairs website www.dia.govt.nz or call 0800 22 51 51. Collection and use of information provided in support of application This application form requires you to produce certain information in support of this application.The decision to supply the information is voluntary. If you do not produce sufficient information to enable a confirmation of New Zealand citizenship to be determined, the application will be declined. The collection of this information is required to see if the requirements of the Citizenship Act 1977 are met, to process the application and for other lawful purposes. The information you provide in this form is collected and held by Department of Internal Affairs, PO Box 10-680, Wellington, New Zealand. You have a right of access to and correction of personal information you have provided under the Information Privacy Principles of the Privacy Act 2020. • I declare that the statements made in this application are to the best of my knowledge true, complete and correct. • I understand that if false information has been provided any citizenship certificate issued on the basis of that information may be cancelled and the matter referred to the New Zealand Police. • I confirm that I have read and understood the statement above relating to privacy. • I consent to information being obtained about me for the purposes of determining eligibility with respect to this application by an authorised information matching programme in accordance with section 78A of the Births, Deaths and Marriages Act 1995· • I authorise any additional enquiries necessary for determining this application for confirmation of New Zealand citizenship. 5. Applicant signature Name ^ Signed ^ Dated ^ 6. Lodging an Application Completed applications or any queries concerning New Zealand citizenship can be sent to: The Citizenship Office Service Delivery and Operations Department of Internal Affairs PO Box 10680, Wellington, New Zealand Applicants who live outside New Zealand may lodge their application at some New Zealand High Commissions, Embassies or Consulates. 7. Fees and payment Please enclose a fee of NZ$112.40 per applicant. Please do not send cash. If you want to pay by cheque or bankdraft, please make it payable to “Department of Internal Affairs”. Please charge my credit card. State what card it is - Mastercard or Visa ^ Credit Card Number ^ Print Full name of Cardholder ^ Expiry date ^ Amount NZ$ ^ Signature ^ Print and sign. Digital signatures are not allowed 8. Proof of identity Can you act as a witness? To act as a witness you must: • not be a relative or partner; and • not live at the same address; and • have known the applicant for more than 12 months, or since birth. The witness must fill in this section in their own handwriting. Personal details of the witness Surname or family name ^ First and middle names ^ Occupation ^ Type your date of birth (DD/MM/YYYY) ^ Type your address and contact details Unit or house number ^ Street name ^ Suburb ^ City or town ^ Country ^ Home phone ^ Work phone ^ Mobile ^ Fax ^ Email ^ I declare that I have known [Enter surname of applicant ^ [Enter first names of applicant ^ for [Enter number of years and months you have known them ^ years and months and confirm their identity. I have written the full name of the applicant, dated and signed my own name on the back of 1 photograph. Witness signature ^ Date signed (DD/MM/YYYY) ^ Please provide 2 passport-sized photos of the applicant. Photo information You need to give 2 identical colour photos that are less than 6 months old, and meet the listed requirements. We strongly recommend that you obtain your photos from a business that provides a passport photo service, as the business will help ensure that your photos meet our requirements. Photos that do not meet our requirements will not be accepted. To help you to avoid some of the most common problems with photo quality, we have summarised the main requirements. If you need more detailed information about photos, call us on 0800 22 51 51. • 2 identical colour photos, less than 6 months old. • Be a full front, close up view of the head and shoulders with the head covering 70% to 80% of the photograph. • Be taken with a neutral expression (not smiling or frowning) with mouth closed. • Show you looking straight at the camera, and their head not tilted. • Show your eyes open and clearly visible, and no hair in their eyes. • Without sunglasses. Tinted prescription glasses may be worn as long as eyes are still visible. • A true image and not altered in any way. • Clear, sharp and in focus with minimum reflective light on face. • No redeye. • With a plain light coloured background (not white). • Be of good quality colour and on high quality photographic paper, with no ink marks on the image (no inkjet printers). • Passport-sized (45mm by 35mm). • Glasses frames must not obscure the eyes. • Do not trim the photos. The authorised person who witnesses the statutory declaration below must write the full name of the applicant on the back of 1 photo,and sign and date it. Please note: Businesses that specialise in taking passport size photos will usually supply 1 with a preprinted label on the back. Contact the Citizenship Office if you require further information on photographic image requirements.