Registration No.

CUCEL
Form 906

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

APPLICATION TO BECOME A CIVIL UNION CELEBRANT

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

This application for and any documentation attached to it will be used to assess your suitability for registration as a Civil Union Celebrant under the Civil Union Act 2006.  If your application is successful you will be included on the Civil Union Celebrant Register.  If your application is unsuccessful you have the right to appeal the decision to the Administrative Appeals Tribunal (AAT).	

DETAILS OF APPLICANT	

1.	Surname		
2.	Given Names		
3.	Date of Birth		4.	Gender		
5.	Principal place of residence (provide evidence eg. Rates notice)		
6.	Postal address if different to above.		
7.	Telephone contact		8.	Fax		
9.	Email contact		10. Mobile		

QUALIFICATIONS, EXPERIENCE AND SKILLS REQUIRED	

You cannot be registered as a Civil Union Celebrant unless you can demonstrate that you have the knowledge, skills and experience to undertake the role.  It may also be necessary for you to attend an interview with the ACT Registrar-General’s Office, if you do not hold relevant qualifications.	
QUALIFICATIONS	Please provide details and copies of certificates awarded to you that may be able to demonstrate your competency to undertake the responsibilities of a Civil Union Celebrant.	
	
SKILLS	Provide details of your ability to liaise and communicate with people who may be from a diverse background, with particular sensitivity to people who may be interested in entering into a civil union.	
	
SKILLS	Provide details showing your ability to conduct a civil union ceremony, to prepare the paperwork associated with the ceremony and lodge the paperwork as required under the Civil Unions Act 2006.	
	
EXPERIENCE	Please complete the following section if you wish to be considered for registration on the basis of your experience.	

BUSINESS INTERESTS OR POSSIBLE CONFLICTS OF INTERESTS	

The following questions have been designed to establish if there is an actual or potential conflict of interest that may arise if you were registered as a Civil Union Celebrant.	
1.	What is your current occupation?		
2.	If you are privately employed, what is the nature of organisation that you work for?		
3.	If you operate your own business, please provide the nature or details of the business.		
4.	Do you believe there would be any conflict of interest if you were registered as a Civil Union Celebrant?  If Yes, please explain.		

CONVICTION OF OFFENCES	

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

Declare that:
	
	 I have / 

 I have not 	been convicted, or found guilty, in Australia of an offence punishable by imprisonment for 1 year or longer. 	
	 I have / 

 I have not 	been convicted, or found guilty outside Australia of an offence that, if it had been committed in the ACT, would have been punishable by imprisonment for 1 year or longer.	
	 I have / 

 I have not 	been convicted, or found guilty, of an offence against, or otherwise contravened, the Civil Unions Act 2006 or the Births, Deaths and Marriages Act 1997 (part 5A – Registration of Civil Unions).	
	 I have

 I have not 	been an undischarged bankrupt or executed a personal insolvency agreement.	
	 I have

 I have not 	a physical or mental incapacity that may affect the exercise of my functions as a civil union celebrant.	
	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		200  .	
	Place where declaration made		Date of declaration		
Before me			
	Full Name of Witness	Signature of Witness	
Address of Witness		
Qualification of Witness		

REFERENCES	

Please provide at least 3 referee reports.  Each referee must be known to you for at least 2 years, but not be a member of your family.  In doing so, the referee must respond to the following items:	
	The nature and length of time the referee has known you as the applicant.	
	The referee’s knowledge of your personal and professional capacity to undertake the responsibility of performing Civil Unions.	
	The referee’s knowledge of any personal or professional standards or qualities that may support your application to become a Civil Union Celebrant.	

AGREEMENT TO MEET THE REQUIREMENTS OF THE CIVIL UNIONS ACT 2006	

If registered as a Civil Union Celebrant, I will:	
A	Conduct myself in accordance with the guidelines regarding being a Civil Union Celebrant.	
B	Undertake any personal and professional development that may be required by the guidelines.	
C	Notify the ACT Registrar-General in writing of any change to my details as placed on the register.	
Signature of Applicant		Date		
Full Name of Applicant		

LODGMENT CHECKLIST	

A	Evidence of your principle place of residence	
B	Evidence of any qualifications you hold or other evidence that may support your application	
C	A completed questionnaire	
D	Three referee reports