Approved form AF 2002-58

made under the
Adoption Act 1993

Adoption Regulations 1993‑Form 3
(see reg 23 (1), reg 29 (1))

Australian Capital Territory
Adoption Act 1993
Memorandum of adoption order
No          of [year]
Date of adoption order:
In the Supreme Court of the Australian Capital Territory

Particulars of adopted child		
Full name before adoption		
Sex		
Date of birth		
Place of birth		
Father’s full name		
Mother’s full name		
Mother’s full maiden name		
Mother’s surname at date of birth of adopted child 		
Full name of child after adoption		
Particulars of adopting parents		
Full name of adopting father		
Occupation		
Address		
Place of birth		
Age at date of birth of adopted child		
Full name of adopting mother		
Occupation		
Address		
Place of birth		
Age at date of birth of adopted child		
*When and where married		
*Previous issue of marriage—
(a)	living (names and ages)

(b)	deceased:      males,      females		
*  Strike out if inapplicable
Date:                                          ,
Registrar of the Supreme Court

Endnotes
1	This form was originally in the Adoption Regulations 1993, schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the regulations and became a form approved under the Adoption Act 1993, section 120A (see amdt 1.62, amdt 1.80).
2	This republication includes amendments made under the Legislation Act 2001, part 11.3 (Editorial changes).

©  Australian Capital Territory 2002