*** 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. *** BDM71 Tono ki te rēhita i te huri ingoa me te whakahou tohu ira tangata ki te tiwhikete whānau Application to register a name change and update sex marker on birth certificate Me whakamahi i tēnei puka hei rēhita i te huri i te ingoa me te whakahou i te tohu ira tangata ki tō tiwhikete whānau o Aotearoa mēnā i rēhitatia tō whānautanga mai i Aotearoa: • 18 ō tau, pakeke ake rānei, tērā rānei • 16, 17 rānei ō tau, kei te mārena, i mārena i mua, kei roto, i roto rānei i te hononga ā-ture, hononga ā-whare rānei. Use this form to register a name change and update the sex marker on your New Zealand birth certificate if your birth was registered in New Zealand and: • you are aged 18 or older, or • you are aged 16 or 17 and are, or have been, in a marriage, civil union or de facto relationship. NGĀ ARATOHU GUIDE NOTES Hei mua i te tononga Before you apply Timeframe To view our current timeframes for a change of name and registered sex, go to: govt.nz/bdmtimeframes. If you have requested a certificate showing your new details, allow extra time for postage. If your application is not correct and complete, your application may be delayed. Guidelines for your new name Your new name must consist of one surname and one or more other names. If your religious or philosophical beliefs, or cultural traditions require you to only have one name, you will need to attach a letter of explanation. The new name (or combination of names) may not be accepted for registration if it: • might cause offence to a reasonable person • is more than 70 characters long, including spaces, without adequate justification • is, includes, or resembles an official title or rank (in which case attach a letter of explanation), or • is not a name (for example, it must not include numbers or symbols). Guidelines for your new sex marker You will need to select one of the following sex markers: • female • male • non-binary. Contact details Website: govt.nz/bdm/contactus Email: bdm.nz@dia.govt.nz Only use email for queries about the form. To return the form, follow the postage instructions on page 13. Do not email the completed form to us. True statements If you make, or cause to be made, any false statement or declaration you will be liable, on conviction, to a fine or up to 5 years imprisonment, or both. Requirements You will need to: 1. Provide a certified true copy of your current photo identification 2. Provide proof of your use of your identity in the community. 3. Make a statutory declaration on pages 7-9 of this form. Refer to below for further information about these requirements. Include an official English translation of any document that is not in the English language. 1. Your current photo identification You must provide a certified true copy of one of the following. It must include your photo. • New Zealand or overseas passport (photo page only) • New Zealand or international driver licence (copy of front and back) • New Zealand or overseas firearms or dealer’s licence • New Zealand or overseas defence force or police service photo identity card • Overseas identity card • 18+ card or Kiwi Access Card (issued by Hospitality New Zealand) or overseas proof of age card A certified true copy is a photocopy that has been stamped or endorsed by an authorised person. For example, a solicitor/lawyer, notary public, registrar of the court or Justice of the Peace. This confirms that the copy is a true copy of the original document. If you do not have photo identification, you will also need to fill out a BDM76 Identity Referee Declaration form and attach it to this application. You can find this form at: govt.nz/birth-certificate-sex. You must present your current photo identification or completed BDM76 form (with attached photo) to the person authorised to take a statutory declaration when you sign the declaration in front of them. They can certify your document at the same time. 2. Proof of the use of your identity in the community You must provide two documents from different sources. These do not need to be certified true copies. For example: • Rates notices • Electoral roll record • Motor vehicle registration • Student or tertiary identity card • Educational certificate or school report • Trade certificate • Steps to Freedom form • Community Services Card • Utility accounts (including gas, water, electricity, mobile or home phone) • Bank statements (including savings, credit or cheque accounts) • Lease or tenancy agreements • Inland Revenue tax number (provide an IR card or statement) • Certificate of Approval or licence issued by the Private Security Personnel Licencing Authority 3. Statutory declaration requirements A statutory declaration is a written statement signed in front of an authorised person and declared to be true. The people below are authorised to take a statutory declaration. New Zealand • Registrar of Births, Deaths and Marriages • Justice of the Peace • Registrar or a deputy registrar of the Supreme Court, Court of Appeal, High Court or a District Court • Person enrolled as a barrister and solicitor of the High Court • Any other person authorised by law to administer an oath Commonwealth country other than New Zealand • Commonwealth representative • Justice of the Peace • Notary Public • Judge • Commissioner of Oaths • Solicitor of the High Court of New Zealand • A person authorised by law to administer an oath for the purpose of judicial proceeding (examples on the next page) Non-Commonwealth country • Commonwealth representative • Notary public • Judge • Solicitor of the High Court of New Zealand Examples of people authorised by the law of Australia, England, Wales, Ireland, Northern Ireland and Scotland to administer an oath for the purpose of judicial proceeding: Australia Australian Police are not authorised to take this statutory declaration unless you are in the Northern Territory. Australian pharmacists, optometrists and doctors are not authorised to take statutory declarations. • Judge • Notary public • Justice of the Peace • Solicitor of the High Court of New Zealand • Australian legal practitioner • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative Also, if in Northern Territory • Commissioner for Oaths (by personal appointment) • Member of the Legislative Assembly • Member of the house of the Parliament of the Commonwealth elected to represent the Territory or a constituency in the Territory • Member of the police force who is 18 years or older Also, if in Queensland • Commissioner for Declarations • Conveyancer Also, if in South Australia • Commissioner for Affidavits Also, if in Western Australia • A mining registrar appointed under the Mining Act 1978 England or Wales • Judge • Comissioner of Oaths (by personal appointment) • Notary public • Justice of the Peace • Solicitor of the High Court of New Zealand • Solicitor • Barrister • Legal executive • Licensed conveyancer • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative Ireland or Northern Ireland • Judge • Notary public • Justice of the Peace • Solicitor • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative • Solicitor of the High Court of New Zealand Scotland • Judge • Notary public • Justice of the Peace • Commonwealth representative • Person authorised by the law of that country to administer an oath for the purpose of a judicial proceeding • Solicitor of the High Court of New Zealand Privacy statement The information provided on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 2021 (the ‘BDMRR’ Act). A person who makes, or causes to be made, a false declaration on this form will be liable on conviction to a fine or term of imprisonment, or both. The new information will be held on a public register, and may generally be accessed by any person on application (e.g. as a certificate or printout). The Department of Internal Affairs may also release it to certain government agencies and foreign registration authorities, as authorised by law. This form, the accompanying certificate, and the details relating to your sex at birth will not be publicly available, except where the Registrar-General is satisfied the information is required in relation to the administration of an estate or trust, a marriage, or by order of a Court. A new birth registration will be made from the information provided. Corrections may be made as provided for in the BDMRR Act. The BDMRR Act governs access to registered information. Information about your rights to access and, where appropriate, correct the information is available on our website govt.nz/bdm or freephone 0800 22 52 52. Fees statement All fees are correct as at the form version date. All fees are in New Zealand dollars. TE TONO APPLICATION 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. • When you see this icon, it means you need to take extra care with your answers. 1. My name 1a. Name at birth This is the name on your birth certificate. If you are legally adopted, enter the names you were given after adoption. All first and middle names ^ Surname ^ 1b. Name from previously registered name change (if applicable) This applies if your current name is different from your name at birth due to a registered name change. It does not apply if you have assumed a surname on marriage or civil union, even if that surname was included on your passport. All first and middle names ^ Surname ^ 2. My date of birth Date (dd/mm/yyyy) ^ 3. My place of birth Town/city ^ Country ^ 4. My contact details Phone number ^ Email ^ My preferred name for contact purposes ^ 5. Indicate whether you want your attached documents to be: Securely destroyed Unchecked ^ Returned to you Unchecked ^ 6. (If 16 or 17 years of age) I am, or have been, in a: Marriage Fill in date and place fields below Unchecked ^ Civil union Fill in date and place fields below Unchecked ^ De facto relationship Unchecked ^ Date of marriage or civil union (dd/mm/yyyy) ^ Place of marriage or civil union ^ The next section is the Statutory Declaration. You will need to sign it in front of an authorised person. Refer to pages 2-3 for the list of people authorised to take a Statutory Declaration. Statutory declaration Take care completing this statutory declaration as you may be required to do it again if there are errors. All corrections must be: • initialled • dated, and • witnessed by a person authorised to take a statutory declaration. 7. I, Enter the name you are currently known by. Full name ^ 8. of Enter your residential address. This cannot be a PO Box. Street number and name ^ Suburb ^ Town or city ^ Country ^ 9. a Enter your occupation. For example, ‘Landscape gardener’ or ‘Home-maker’. If you have no occupation, enter ‘No occupation’. Occupation ^ solemnly and sincerely declare that: I authorise any necessary additional enquiries including the disclosure of personal information about myself for the purpose of determining eligibility for the name change part of the application. My authorisation includes any information held by the Department of Internal Affairs or another New Zealand government agency. 10. The name I want to register on my birth certificate is: Refer to the ‘Guidelines for your new name’ on page 1. All first and middle names ^ Surname ^ If you are married or in a civil union Surname assumed through marriage or civil union. Generally, you do not need to register the surname you assumed through your marriage or civil union. This is because organisations may acknowledge your new surname using some other evidence. For example, your marriage certificate. You also cannot register if you change back from using your assumed surname to using your birth surname. Only changing your first name(s). If you are married or in a civil union and only want to change your first name(s), enter the surname of your new name as it is currently recorded on your birth registration. Do not print the surname you assumed through marriage. 11. I advise that I intend to use my new name once my name is registered. If you are already using your new name tick this box Unchecked ^ 12. And I solemny and sincerely declare that: • I identify as a person of the sex marker selected below; and • I understand that any future birth certificates will show the selected sex marker in the sex field. Select one: Female Unchecked ^ Male Unchecked ^ Non-binary Unchecked ^ 13. Fill out and sign this section before a person authorised to take a statutory declaration (Refer to pages 2-3 for the list of authorised people.) And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957. Declared at (Town or city and country) ^ this day of (dd/mm/yyyy) ^ by (Signature of declarant) ^ 14. The person authorised to take a statutory declaration must complete this section I am satisfied of the applicant’s identity because (tick one): I have sighted the applicant’s original photo identification document from the list on page 2 (write document name and number below). Unchecked ^ Document name (e.g. New Zealand passport) ^ Document number (e.g. Passport number) ^ I have sighted the applicant’s photo on a fully completed BDM76 Identity Referee form. Unchecked ^ Signature (Authorised person signs here) ^ Full name of authorised person ^ Qualification of authorised person ^ End of Statutory Declaration. Continue to sections 15-20 of the form. 15. Human Assisted Reproductive Technology Register (HART) Are you a donor or person born as a result of a HART procedure? Yes Unchecked ^ Fill in this section. No Unchecked ^ Go to Section 13. This section applies if you were born as a result of an assisted reproductive technology procedure using donated sperm, eggs or embryos through a fertility clinic. If the information has been provided to Births, Deaths and Marriages for inclusion on the HART Register, it will be updated to include your new name. This means that up-to-date information will be provided to persons who are authorised to access your information under the Human Assisted Reproductive Technology Act 2004. Donation made after 21 August 2004 If your birth occured as a result of a donation made after 21 August 2004, information will be sent to a fertility clinic. We can send information about the name change to the fertility clinic. They can then update their records. Yes, I consent to my new name being sent to the fertility clinic named below that holds the information: Unchecked ^ Fertility clinic name ^ 16. Application fees The application fee to register a name change is $170. The application fee to update a sex marker is $55. 17. Birth certificate (additional fee) You can order a birth certificate if you need a certificate that shows your new details. If you do not need a certificate to prove your new sex marker or name, this is optional. There are several types and packages of birth certificate that you can select from. Enter quantity: Standard certificate $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 ^ 18. Note your new name on your New Zealand marriage or civil union record (additional fee) You can have your new name noted on your marriage or civil union if: • you are currently married or in a civil union, and • your marriage or civil union is registered in New Zealand. This will cost $55. You can also order a marriage or civil union certificate. This will cost $33. Your new sex marker cannot be added to your marriage or civil union record. Select boxes that apply: I want my new name noted on my New Zealand marriage or civil union $55 Unchecked ^ I would like to order a new marriage or civil union certificate after my new name is noted on my New Zealand registered marriage or civil union $33 Unchecked ^ Details of your most recent marriage or civil union: Marriage Unchecked ^ Civil union Unchecked ^ Date of marriage or civil union (dd/mm/yyyy) ^ Place of marriage or civil union ^ 19. Delivery of birth, marriage or civil union certificate (if applicable) Select a delivery method: I want the certificate(s) sent by standard post $0 Unchecked ^ I want the certificate(s) couriered to a New Zealand address $5 Unchecked ^ I want the certificate(s) couriered to an overseas address $15 - $30 Unchecked ^ 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 on page 1. Delivery address ^ Delivery name ^ Street number and name ^ Suburb ^ Town or city ^ Country ^ Postcode ^ Complete the payment section on the last page of the form. Do not post cash or card. Do not email credit card details. Payment Charge my credit or debit card (Visa, MasterCard, American Express, Prezzy Card): Card number ^ Card expiry date ^ Name on card ^ Cardholder signature ^ Next steps Print and sign the form. Post the form, appropriate fee(s), and documents to us. New Zealand office: Births, Deaths and Marriages Department of Internal Affairs PO Box 10-526 Wellington 6140 New Zealand Sydney office: Births, Deaths and Marriages Department of Internal Affairs GPO Box 365 Sydney New South Wales 2001 Australia London office: Births, Deaths and Marriages Department of Internal Affairs 1 Pall Mall East London SW1Y 5AU United Kingdom