BIRTHS, DEATHS AND MARRIAGES
OFFICE OF REGULATORY SERVICES
Department of Justice and Community Safety

ACP
Form 219

APPLICATION TO REGISTER A
CIVIL PARTNERSHIP
Civil Partnerships Act 2008
Births, Deaths and Marriages Registration Act 1997
Births, Deaths and Marriages Registration Regulation 1998

Registration Number 
(office use only)

IMPORTANT INFORMATION
Applicants should be aware of their responsibilities under the Civil Partnerships Act 2008.  You can view the Act and its regulations or download them from www.legislation.act.gov.au.  You may also obtain information and relevant forms at www.ors.act.gov.au.  The Civil Partnerships Act 2008 and the Births, Deaths and Marriages Registration Act 1997 authorise 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 authorized organisations that have the legal authority to request information under prescribed circumstances.

Send completed applications to the Office of Regulatory Services:  	GPO BOX 158, CANBERRA   ACT   2601
Or provide in person at:						255 Canberra Avenue, Fyshwick.
Or call for assistance on:						02 6207 0460

GENERAL INFORMATION
A civil partnership provides a way for two adults, over 18 years of age, who are in a relationship as a couple, regardless of their sex, to have their relationship legally recognised by registration as a civil partnership.  To enter into a civil partnership the proposed civil partners must not be married, be in another civil partnership, or be in a prohibited relationship.  A prohibited relationship between proposed civil partners is defined as being a lineal ancestor, lineal descendent sibling or half sibling.  A least one of the proposed civil partners must be a current resident of the Australian Capital Territory (ACT).  

YOU MUST PROVIDE ALL OF THE FOLLOWING AS PART OF YOUR APPLICATION
(To assist ORS in assessing your application, please tick what is attached)	

	PARTNER 1	PARTNER 2	
A Birth Certificate (if born in Australia), OR		Cert No		Cert No	
Citizenship Certificate, (if born outside Australia) OR		Cert No		Cert No	
Current Passport (if born in Australia, an Australian Passport)		Passport No		Passport No	
Evidence of Residency 
(may include bills, bank statements etc, that have been current ACT residential address and must be dated 3 months prior to your application, and dated less than 6 months prior to your application)		Detail what was provided		Detail what was provided	

OFFICE USE ONLY - FOR COMMITMENT CEREMONIES OR ENDORSEMENT BY THE DEPUTY REGISTRAR-GENERAL THE FOLLOWING WILL BE REQUIRED AT INTERVIEW	

Date of Ceremony		
Time of Ceremony		
Venue		
Deputy Registrar-General to Undertake Commitment Ceremony and Endorsement	 Yes    No	

Approved form AF2008–32 approved by Brett Phillips, Registrar-General on 15 May 2008 under section 19 of the Civil Partnerships Act 2008  (approved forms) New Form.

Deputy Registrar-General ONLY to undertake Endorsement	 Yes    No	

PRESCRIBED PARTICULARS OF PROPOSED CIVIL PARTNERS	

	PARTNER 1	PARTNER 2	
Surname
(as written on your POI document)	     	     	
Given names
(as written on your POI document)	     	     	
Occupation	     	     	
Usual place of residence
(one of the partners must be permanently resident in the ACT)	     	     	
Place of birth 
(insert city/town, Australian State or Territory, or if born overseas, city/town and country)	     	     	
Date of birth	     	     	
Relationship status
(specify single, divorced, widowed or domestic partnership other than proposed civil partner)	     	     	
Mother’s surname	     	     	
Mother’s full given names	     	     	
Father’s/
Parent’s surname 
(specify if father or parent)	     	     	
Father’s/
Parent’s full given names
(specify if father or parent)	     	     	

STATUTORY DECLARATION BY CIVIL PARTNER/S AND ENDORSEMENT BY REGISTRAR-GENERAL	

PARTNER 1	PARTNER 2	

I,				________________

of 				________________

hereby solemnly declare that I wish to enter into a civil partnership with

					__________

And that I am not married or in a civil partnership, and believe I do not have a prohibited relationship with my proposed partner

Signature ________________________________

I,				________________

of 				________________

hereby solemnly declare that I wish to enter into a civil partnership with

					__________

And that I am not married or in a civil partnership, and believe I do not have a prohibited relationship with my proposed partner

Signature ________________________________
	
Declared at ______________________________ Canberra, ACT on _____________________________

Before me _______________________________ Qualification of witness ________________________ 	

ENDORSEMENT BY THE REGISTRAR-GENERAL OR DEPUTY REGISTRAR-GENERAL	
In accordance with Section 8 of the Civil Partnerships Act 2008 (the Act) both parties have satisfied the requirements of Section 6 of the Act and as such I now endorse this application for the purpose of registration under the Act.	
Signature of Deputy Registrar 	Dated 	
Full Name of Deputy Registrar-General