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

APPLICATION TO REGISTER A
CIVIL PARTNERSHIP WITHOUT CEREMONY 		
Form 219 - ACP	

	Civil Partnerships Act 2008
Births, Deaths and Marriages Registration Act 1997
Births, Deaths and Marriages Registration  Regulations 1998		

IMPORTANT INFORMATION
This form can be used to apply to the Registrar-General for an endorsement of a relationship as a civil partnership. 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 or sibling or half sibling. At least one of the proposed civil partners must be a current resident of the Australian Capital Territory (ACT).  Applicants should be aware of their responsibilities under the Civil Partnerships Act 2008. You can view or download the Act from www.legislation.act.gov.au. 
	
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 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.
	
CONTACT INFORMATION	
Send completed forms to 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 print clearly and 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 or correction tape.
•	If lodging the application in person, you must supply original identification documents and three forms of evidence of residency.
•	If lodging the application by post, you must have all identification documents, evidence of residency and signatures witnessed by a person appropriately qualified under the Statutory Declarations Act 1959 (C’wlth) 
•	An application for civil partnership where there is no ceremony performed, may only be endorsed by the Registrar-General or a Deputy Registrar-General.  	
TRANSLATING AND INTERPRETING SERVICE
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.	

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

APPLICATION TO REGISTER A
CIVIL PARTNERSHIP WITHOUT CEREMONY 		
Form 219 - ACP	

	Civil Partnerships Act 2008
Births, Deaths and Marriages Registration Act 1997
Birth, Deaths and Marriages Registration Regulations 1998		

Registration Number
(Office use only)			Contact Phone number 		

DETAILS OF PARTNERS 	
	PARTNER 1	PARTNER 2	
Surname
(As appears on your POI document)			
Given Name(s)
(As appears on your POI document)			
Occupation			
Usual Place of Residence
(One of the parties must reside in the ACT)			
Place of Birth
(City/Town, Australian State or Territory, or if born overseas, city/town and country)			
Date of Birth			
Relationship Status
(other than relationship with proposed civil partner)	 Single             Domestic Partnership
 Widowed       Divorced	 Single             Domestic Partnership
 Widowed       Divorced	
Mother’s Surname			
Mother’s Given Name(s)			
Father’s Surname			
Father’s Given Name(s)			

PROOF OF IDENTIFICATION (POI)	
PARTNER 1	
 	A Birth Certificate; or, 
(If born in Australia)	 	Current Passport; or,
(If born in Australia, an Australian Passport)	 	Citizenship Certificate
(If born outside Australia) 	
Certificate Number	Passport Number	Certificate Number	
Evidence of Residency (Include bills, bank statements etc that have an ACT residential address and are dated between 3 and 6 months prior to the application)	
	
PARTNER 2	
 	A Birth Certificate; or, 
(If born in Australia)	 	Current Passport; or,
(If born in Australia, an Australian Passport)	 	Citizenship Certificate
(If born outside Australia) 	
Certificate Number	Passport Number	Certificate Number	
Evidence of Residency (Includes bills, bank statements etc that have an ACT residential address and are dated between 3 and 6 months prior to the application)	

STATUTORY DECLARATION BY CIVIL PARTNER(S)	
PARTNER 1	PARTNER 2	
I, (full name)	I, (full name)	
being a (occupation)	being a (occupation)	
of (address)	of (address)	
	Postcode		Postcode	

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

…………………………………………………..………………….(name of partner 2)

and that I am not married or in a civil partnership, and believe I do not have a prohibited relationship with my proposed partner.
	hereby solemnly declare that I wish to enter into a civil partnership with 

……………………………………………………………………….(name of partner 1)

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  (of partner 1)	……………………………………………………………………………………………..Signature (of partner 2)	

DETAILS OF WITNESS	
Declared at (place) 	on (date) 	
Before me, (Full Name of Witness)	
Of (address 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	
Signature (of the witness)	

ENDORSEMENT BY THE REGISTRAR-GENERAL OR A DEPUTY REGISTRAR-GENERAL	

In accordance with Section 8 of the Civil Partnerships Act 2008 (the Act) both parties have satisfied the requirements of Sections 7 of the Act and as such I now endorse this application for the purpose of registration under the Act. 
	
Full Name (of Deputy Registrar)	
……………………………………………………………………………………………..Signature  (of Deputy Registrar)	……………………………………………………………………………………………..Date of Endorsement