Registration No.

CCU
Form 905

ACT GOVERNMENT
Civil Unions Act 2006
Registrar-General’s Office

CONSENT TO ENTER INTO A CIVIL UNION

PRIVACY COLLECTION STATEMENT (PRIVACY ACT 1988 (CTH)) 

PRIVACY NOTES

The Births, Deaths and Marriages Registration Act 1997 authorises the Registrar-General to collect the information required by this form for the establishment and maintenance of registers.  The Registrar-General prevents any unreasonable intrusion into a person’s privacy in accordance with the Privacy Act 1988 (Cth).  	

GENERAL INFORMATION

A person who is over the age of 16 or under 18 years old may enter into a civil union only if:
a.	The Children’s Court by order, gives an authorisation for the person to enter into a civil union; and 
b.	Each person with responsibility to make long-term decisions for the person (parent, guardian) gives written consent to the person entering into the civil union, or the requirement for consent is waived by the court.	

DETAILS OF PERSON SEEKING CONSENT	

1.	Surname		
2.	Given Names		
3.	Usual place of residence 		
4.	Birthplace 		
5.	Date of birth		

CONSENT BY PERSONS WITH RESPONSIBILITY FOR LONG TERM DECISIONS FOR THE ABOVE PERSON	

Statutory Declaration	PARENT / GUARDIAN	PARENT / GUARDIAN	
	
I,					
(full name, address and occupation of person making the declaration)

Declare that I consent to:

(full name of the child seeking to entering into a civil union)

entering into a civil union under the Civil Unions Act 2006.

I make this declaration under the Statutory Declarations Act 1959, and I believe the statements to be true in every particular.	
I,					
(full name, address and occupation of person making the declaration)

Declare that I consent to:

(full name of the child seeking to entering into a civil union)

entering into a civil union under the Civil Unions Act 2006.

I make this declaration under the Statutory Declarations Act 1959, and I believe the statements to be true in every particular.	
Signature of Person Making Declaration			
Declared at		Canberra, ACT on		2006.	
	Place where declaration made		Date of declaration		
Before me			
	Full Name of Witness	Full Name of Witness	
Signature of Witness			
Address of Witness