ADP
Form 202

ACT GOVERNMENT
Births, Deaths and Marriages Registration Act 1997
Registrar-General’s Office

APPLICATION TO DECLARE PARENTAGE

PRIVACY COLLECTION STATEMENT (PRIVACY ACT 1988 (C’WLTH))

PRIVACY NOTES

The Births, Deaths and Marriages Registration Act 1997 authorises the Registrar-General to collect the information required by this form in processing your application.  The Registrar-General prevents any unreasonable intrusion into a person’s privacy in accordance with the Privacy Act 1988 (C’wlth).  However, the Registrar-General provides identifiable information to law enforcement organisations and authorised organisations that have the legal authority to request information under prescribed circumstances.	

GENERAL INFORMATION

This form can be used to include details of a parent in the register of births, after a child’s birth has been registered.  Parent of a child means the child’s mother, father or someone else who is presumed to be a parent under the Parentage Act 2004.  Both parents must provide 3 forms of identification upon application.	

FEES CURRENT TO 30 JUNE 2007

There is no fee to lodge an application to declare parentage, however a fee does apply if a new birth certificate is required after the birth register is updated.  If you wish to apply for a new birth certificate after the birth register is updated please complete an application for certificate form.	

CONTACT DETAILS

The Registrar-General’s Office is located at 255 Canberra Avenue, Fyshwick ACT 2609.  Our postal address is PO Box 225, Civic Square ACT 2608.  Our office hours are 8:30am to 4:30pm Monday to Friday.  You may also download forms and information from our website at www.rgo.act.gov.au  or contact this office on (02) 6207 0460.	

WITNESSES TO SIGNATURES AND CERTIFIED COPIES OF DOCUMENTS

If you are lodging this application in person you must supply original identification documents.  If sending your application by post you must have the identification documents certified as true copies of the original documents by a Justice of the Peace, Solicitor or Police Officer.  If you are lodging this application in person all signatures may be witnessed by Births, Deaths and Marriages staff within the Registrar-General’s Office.  If you are sending your application by post all signatures must be witnessed by a Justice of the Peace, Solicitor or Police Officer. 	

Telephone Interpreter Services	

If English is not your first language, and you need help with this form, please telephone 131 450 for assistance 24 hours a day.

Registration No

ADP
Form 202

ACT GOVERNMENT
Births, Deaths and Marriages Registration Act 1997
Registrar-General’s Office

APPLICATION TO DECLARE PARENTAGE

PART A – DETAILS OF CHILD AT TIME OF BIRTH	
Surname		Given names	
     		     	
Date of birth		Place of birth	
     		     	

PART B – MOTHER  PARENT  DECLARATION 	
I, (full name)	                                                                                                         being a (occupation)	
of (address)		Postcode	
hereby apply to the Registrar-General to include the parentage details of the father/parent described in part C of this form on the birth registration of the child named in part A of this form, and solemnly and sincerely declare that the statements made in this application are true and correct by virtue of the Statutory Declarations Act 1959 and are subject to penalties provided by that Act for making false statements.	
Declared at (suburb/town)		State/Territory	
     		     	
Mother/Parent signature	Dated on	
     		     	
Before me (signature of witness)		Qualification of witness (JP, Solicitor, Police Officer or BDM Staff)	
     		     	
Telephone contact of witness		Full name of witness	
     		     	
Address of witness	
     	

PART C – FATHER  PARENT  DECLARATION 	
I, (full name)	                                                                                                          being a (occupation)	
of (address)		Postcode	
hereby apply to the Registrar-General to include my details as the father/parent of the child described in part A of this form, and solemnly and sincerely declare that the statements made in this application are true and correct by virtue of the Statutory Declarations Act 1959 and are subject to penalties provided by that Act for making false statements.	
Date of birth	Place of birth	Occupation at time of child’s birth	
     		     		     	
Declared at (suburb/town)	State/Territory	
     		     	
Father/Parent signature	Dated on	
     		     	
Before me (signature of witness)		Qualification of witness (JP, Solicitor, Police Officer or BDM Staff)	
     		     	
Telephone contact of witness		Full name of witness	
     		     	
Address of witness