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

APPLICATION TO ALTER BIRTH REGISTER
 TO RECORD CHANGE OF SEX 	
Form 204 - ACS	

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

IMPORTANT INFORMATION
This form may be used to apply to the Registrar-General for alteration of a person’s sex in the registration of the person’s birth if:
•	the person is at least 18 years of age; and
•	the person’s birth is registered in the ACT; and
•	the person has received appropriate clinical treatment for the alteration, or is an intersex person.

This form may also be used by the parent(s) or person(s) with parental responsibility for a child to apply for the alteration of a child’s sex in the registration of a child’s birth if:
•	the child’s birth is registered in the ACT;
•	the child has received appropriate clinical treatment for the alteration, or is an intersex person; and
•	the parent(s) or person(s) with parental responsibility believe on reasonable grounds that the alteration is in the child’s best interests. 
One parent may make application if only one parent is named in the child’s birth registration or if the other parent is deceased, in which case a copy of the death certificate is required.

The application must also be accompanied by a statutory declaration from a doctor or psychologist certifying that the person has received appropriate clinical treatment for the alteration or is an intersex person.
The fee to lodge an application to alter the birth register to record of change of sex is $41.00. If you wish to apply for a new birth certificate after the alteration is made, please complete an application for certificate form. The fee to apply for a new certificate is $41.00 and if the certificate is to be sent by mail, a further $8.00 registered person-to-person postage fee applies.  	
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 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 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 a black pen and substitute information must be clear and all parties must sign in the margin. Do not use white out.
•	If lodging the application in person, you must supply original identification documents.
•	If lodging the application by post, you must have all identification documents certified as true copies of the originals by a person who is authorised under the Statutory Declarations Act 1959 (C’wlth) (eg Justice of the Peace, Solicitor or Police Officer).
•	If lodging the application by post, all signatures must be witnessed by a Justice of the Peace, Solicitor or Police Officer.
•	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 ALTER BIRTH REGISTER
 TO RECORD CHANGE OF SEX 		
Form 204 - ACS	

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

Registration Number
(Office use only)			Date received 
(Office use only)	/                    /	

DETAILS OF PERSON WHOSE BIRTH REGISTRATION IS TO BE ALTERED	
Current Surname	Current Given Name(s)	
		
Surname at Time of Birth	Given Name(s) at Time of Birth	
		
Date of Birth	Place of Birth (where in the ACT)	
/                /			
Sex on Birth Certificate	
 Male                       Female                      Unspecified/indeterminate/intersex   
 Unspecified          Indeterminate       Intersex	
Current Residential Address	
	Postcode	
Current Postal Address (If different)	
	Postcode	
DETAILS OF PARENTS 	
Mother’s Surname	Mother’s Given Name(s)	
		
Mother’s Former Surname Name (If any)	Mother’s Former Given Name(s) (If any) 	
		
Father’s / Parent’s Surname	Father’s / Parent’s Given Name(s)	
		
Father’s / Parent’s  Former Surname Name (If any)	Father’s / Parent’s Former Given Name(s) (If any) 	
		
DETAILS OF CLINICAL TREATMENT 	
Date treatment received 	Name of Doctor or psychologist providing appropriate clinical treatment (statutory declaration from them to be attached)	
_____/_____/_____ - _____/_____/_____		
Sex identification after treatment	
 Male                       Female                      Unspecified/indeterminate/intersex 		

Sex to be included on birth certificate and on other BDM certificates (please tick one box)	
 Male                       Female                      Unspecified/indeterminate/intersex   
 Unspecified          Indeterminate       Intersex		
DECLARATION BY APPLICANT/MOTHER/PERSON WITH PARENTAL RESPONSIBILITY	
I, (full name)	being a (occupation) 	
of (address)	
make the following declaration under the Statutory Declarations Act 1959:
•	I hereby apply to the Registrar-General to alter the sex listed on the birth registration of the person listed as the applicant on this form.
•	If the change of sex is for a child, I am the child’s parent or have parental responsibility and believe that the alteration of the record of the child’s sex is in the best interests of the child.
•	I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.	
Signed 
(applicant’s/mother’s/guardian’s 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	
DECLARATION BY FATHER/PARENT/PERSON WITH PARENTAL RESPONSIBILITY	
I, (full name)	being a (occupation) 	
of (address)	
make the following declaration under the Statutory Declarations Act 1959:
•	I hereby apply to the Registrar-General to alter the sex listed on the birth registration of the person listed as the applicant on this form.
•	If the change of sex is for a child, I am the child’s parent or have parental responsibility and believe that the alteration of the record of the child’s sex is in the best interests of the child.
•	I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.	
Signed
(father’s/parent’s/guardian’s 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 	
 Visa            Mastercard	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.