BIRTHS, DEATHS AND MARRIAGES
OFFICE OF REGULATORY SERVICES
Justice and Community Safety Directorate
APPLICATION TO REGISTER A
CHANGE OF NAME FOR AN ADULT		
Form 206 - CNA	

	Births, Deaths and Marriages Registration Act 1997
Births, Deaths and Marriages Registration Regulation 1998		
	
GENERAL INFORMATION
This form can only be used to register a change of name for an adult whose birth is registered in the ACT, or who is currently a resident of the ACT and has been for more than 3 months.  If you were born overseas you must be an Australian citizen or permanent Australian resident.  It is not necessary to register a change of name where you are assuming your partners name through a marriage that occurred within Australia.

The Registrar-General will not register a change of name unless satisfied of the identity and age of the person whose name is to be changed and that the change is not sought for a fraudulent or other improper purposes.

If your application to register a change of name is approved, an entry will be created in the change of name register. If you were born in the ACT, the new name will also be noted on your birth registration and will appear on all birth certificates issued after registration of the change of name. If you were born in another State or Territory within Australia, the Registrar-General of that jurisdiction will be notified of the change of name and it may appear on birth certificates subsequently issued by that jurisdiction. 	
REFERRAL TO THE AUSTRALIAN FEDERAL POLICE (AFP) AND OTHER AGENCIES AND CONSENT TO RELEASE INFORMATION
This form and any evidence produced in support of this application may be directed to the AFP to assist the Registrar-General in assessing your application.  This form may also be directed to agencies including (but not limited to) other Birth, Death and Marriage Registries, the Passports Office, Department of Immigration and Citizenship, and Motor Vehicle Registries. Usually these referrals are simply to verify the evidence that you have provided in making your application. If there are discrepancies, we may require you to correct any errors with the issuing agency prior to being able to register the change of name application. It is extremely important that all identity documents are accurate and reflect the correct identity information.

In all cases it is necessary for you to consent for the Registrar-General to require the AFP or other agencies to release information available to them that may assist the Registrar-General in making his/her decision.  As a result, as you complete this form it is assumed that you are consenting to the release of information by these agencies in support of your application.
 
Documents provided as proof of identity may have their authenticity verified through Certificate Validation System (CVS) and the National Document Verification System (DVS). Documents issued by this office may also be verified by external agencies using CVS and/or DVS.
	
REASONS YOUR APPLICATION MAY BE REJECTED
The Registrar-General may refuse to register your change of name application if you:
	
•	Have previously offended; or	•	Have outstanding debts; or	
•	Have significant association with an offender; or	•	Desired name is a prohibited name; or	
•	Are unable to produce the required proof of identity documents; or	•	A registered change of name has been performed in the last 12 months; or	
•	Have failed to advise of previous changes of name in the ACT or other jurisdiction; or	•	Have failed to prove ACT residency.	
•	Are currently involved in an investigation; or		

If you are able to demonstrate that the information used by the Registrar General has been superseded, then the change of name application can be reviewed.
	
PRIVACY INFORMATION.
The Births, Deaths and Marriages Registration Act 1997 authorises the Registrar-General to collect the information required by this form. The Registrar-General prevents any unreasonable intrusion into a person’s privacy in accordance with the Privacy Act 1988 (C’wlth). The Registrar-General may provide identifiable information to law enforcement organisations and authorised organisations that have legal authority to request information under prescribed circumstances. Documents provided as proof of identity may have their authenticity verified through Certificate Verification System (CVS) and the Document Verification System (DVS). Documents produced by this office may also be verified by external agencies using CVS and/or DVS.	
If you require further information or need advice, a language assistance service is available by phoning the Translating and Interpreting Service (TIS) on 13 14 50.

PROOF OF IDENTITY, RESIDENCY AND OTHER DOCUMENTATION REQUIRED
Upon application, you must provide sufficient evidence to allow the Registrar-General to be satisfied of your identity. This includes, but is not limited, to the following:
•	Your original birth certificate
•	If born overseas, we will require a current Australian Passport, Australian Citizenship Certificate or entry visa. The entry visa must demonstrate that the applicant is a permanent Australian resident, applications will not be registered for temporary visa holders. If you are unable to provide any of these documents but  are a permanent resident of Australia, you must provide a Certificate of Evidence of Resident Status, available from the Department of Immigration and Citizenship.  
•	If not born in the ACT, we require two forms of evidence proving residency in the ACT (see table below). 
•	If you have previously changed your name through marriage, by registered deed poll or by registered change of name, we require evidence of those changes of name.
•	Three forms of current identification must be provided upon application. At least one form must be Primary Identification and two other forms must be Secondary identification.   In cases where a person is unable to provide enough forms of identification please contact this office.	
Primary Proof of Identity	Secondary Proof of Identity	Proof of Residency	
Photographic Drivers Licence issued in Australia(current or expired up to 2 years	Current Medicare Card	A photographic drivers licence issued in the ACT	
	Current Credit Card or Account Card	ACT Rates Notice or Land Tax valuation Notice	
Australian or Overseas Passport (current or expired up to 2 years)	Current Centrelink or Department of Veteran Affairs Concession Card	Contract or Purchase, Current Lease or Rental Documentation issued by rental estate agency or ACT Government	
Australian Citizenship Certificate or Naturalisation Certificate	ACT Services Access Card issued by ACT Government (Asylum seekers)	Australian Taxation Assessment Notice (last or current financial year or taxi file number notice	
Dept of Immigration and Citizenship travel documentation (valid up to 5 year after issue)	Australian-issued Security Guard/Crowd Controller Licence (with photo)	Utility Accounts relating to nominated address and paid within the last 6 months	
Australian Birth Certificate	Australian Issued Firearm Licence (with photo)	Pay Television Account or Landline Telephone Account paid within the last 6 months	
Dept of Immigration and Citizenship Certificate of Evidence of Resident Status	Current Student Identity Document (with photo)	Home Contents Policy dated within 1 year of application	
Police Officer Photo Identity (ACT only)	Current State, Territory or Federal Government employee photo-identity card
	Motor Vehicle Insurance Policy dated within 1 year of application	
Australian Proof of Age Card		Current Health/life Insurance Policy or renewal Notice within 1 year of application	
CONTACT INFORMATION	
Send completed forms to the Office of Regulatory Services	GPO Box 158, Canberra ACT 2601	
Lodge in person at the Office of Regulatory Services:	255 Canberra Avenue, Fyshwick ACT 2609	
Office Hours:	9:00am to 4:30pm Monday to Friday	
General enquiries telephone number:	(02) 6207 3000	
Website address:	www.ors.act.gov.au 
	
INSTRUCTIONS FOR COMPLETION
•	If completing this form by hand please use black pen only.
•	This office will not accept lodgement of this form if it is not completed in full.
•	Any alteration to information provided on this form must be struck through with black pen and substitute information must be clear and all parties must sign in the margin.  Do not use white out.
•	If you are lodging this application in person you must supply original documentation.
•	If you are lodging this application in person, staff of Births Deaths and Marriages within the office may witness signatures.  
•	If sending your application by post you must have documents certified as true copies of the originals by a person authorised under the Statutory Declarations Act 1959 (C’wlth).
•	If sending your application by post a Justice of the Peace, Solicitor or Police Officer must witness all signatures.
	
FEES CURRENT UNTIL 30 JUNE 2013
The fee to lodge an application to change a name is $101.00.  This fee is non-refundable regardless of whether your application is registered. Upon registration a further $40.00 fee is payable to obtain the certificate of change of name or an updated birth certificate. If the certificate is to be sent by post a $8.00 registered person to person postage fee applies, or $18.00 if it is sent by international registered post. Payment may be made by cash, credit card, EFTPOS, money order or cheque. All cheques and money orders should be made payable to the Registrar-General. Applications paid by personal cheque will be held for 7-10 working days for the cheque to clear.	

	BIRTHS, DEATHS AND MARRIAGES
OFFICE OF REGULATORY SERVICES
Justice and Community Safety Directorate
APPLICATION TO REGISTER A
CHANGE OF NAME FOR AN ADULT		
Form 206 - CNA	

	Births Deaths and Marriages Registration Act 1997
Births Deaths and Marriages Registration Regulation 1998		

Registration Number
(Office use only)			Applicants Contact Number		

DETAILS OF APPLICANT AT THE TIME OF THEIR BIRTH	
Surname at Time of Birth	Given Name(s) at Time of Birth	
		
Date of Birth	Place of Birth	Sex	
        /          /		 Female    Male	

CURRENT DETAILS OF THE APPLICANT (The name you currently use)	
Current Surname 	Current Given Name(s) 	

DESIRED NAME (The name you would like to be known as after the change of name has been registered)	
Surname 	Given Name(s) 	

REASON FOR CHANGE OF NAME (must be specific if not enough room attach separate sheet)	

	

APPLICANTS CONTACT DETAILS	
Current Residential Address	Postal Address (If different from residential address)	
		
	Postcode		Postcode	

DETAILS OF APPLICANTS MOTHER	
Surname	Given Names	
		
Former Names if Any	Date of Birth	Place of Birth	
	      /       /		

DETAILS OF APPLICANTS FATHER   PARENT  	
Surname	Given Names	
		
Former Names if Any	Date of Birth	Place of Birth	
	      /       /		

ANY PREVIOUS CHANGES OF NAME (Includes Deed Poll, Registered Change of name, names known by use, repute or through Marriage)	
Old Name	New Name	
		
Place of Change	Method of Change (ie, Deed poll)	Date of Change	
		        /        /	

Old Name	New Name	
		
Place of Change	Method of Change 	Date of Change	
		        /        /	

Old Name	New Name	
		
Place of Change	Method of Change 	Date of Change	
		        /        /	

DECLARATION BY APPLICANT	
I, (full name)	being a (occupation) 	
of (address)	
hereby apply to the Registrar-General for registration of a change of name to:	
New Full Name	
	
I acknowledge and declare that I have read the general information document provided with this form and the information I have provided on this form relates to me and is correct.  I understand that the Registrar-General may provide this form and any evidence in support of this application to the Australian Federal Police (AFP) or agencies including, but not limited to, other Birth, Death and Marriage Registries, the Passports Office, the Department of Immigration and Citizenship, and Motor Vehicle Registries. I also give my consent for these agencies to release any relevant information to the Registrar-General that he/she may require in order to be satisfied that my application is not being sought for fraudulent or improper purposes. 	
Signed (applicants  signature)	Declared at (place) 	on (date) 	
Before me, (signature of witness)	Full Name of Witness	
Qualification of Witness 
Must be authorised under the Statutory Declarations Act 1959 (C’wlth) (eg Justice of the Peace, Solicitor, Police Officer ) or BDM Staff	
Address of Witness	

PAYMENT DETAILS 	
	Expiry Date	______ / ______	Amount 	$	
Cardholder Name		Cardholder Signature		
Card Number																				
	
PLEASE NOTE: Payments may be made by cheque, money order or credit card if lodged by post, or also by cash or EFTPOS if lodged in person.  Applications paid by personal cheque will be held for 7-10 working days for the cheque to clear.