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Application by the adult child for subsequent registration of a child’s father Births, Deaths and Marriages Registration Act 1996 To be completed by the adult child (18+ years) The Registry is collecting this information to assess eligibility to amend the birth register. If approved, the details provided on this form will be used to amend the birth register to include the birth father's details. If you knowingly make false or misleading representations on the application form, you may be guilty of an offence under Section 53 of the Births, Deaths and Marriages Registration Act 1996 (‘the Act’). I, (adult child’s full name) _________________________________________________________________________________ of (residential address) ___________________________________________________________________________________ (phone number)________________________________ (email address)____________________________________________ i.
I was born on (child’s date of birth)__________________at (child’s place of birth)_____________________________ ii.
My mother is (mother’s full name)___________________________________________________________________ iii.
I believe that my birth father is (father’s full name)______________________________________________________ iv.
Who was born on (date of birth)_______________________ at (place of birth) _______________________________ v.
I declare that the information provided in this form is true and correct. (adult child’s signature) ______________________________________________ (date) _______________________ Proof of Identity You must provide certified copies of identity documents to satisfy the Registry’s proof of identity requirements. Please refer to the identity requirements on the reverse side of this form. Privacy The information requested on this form is collected under the provisions of the Act. The information is collected in order to assess your application to amend the register. The information will not be used for any other purpose. The Registrar may only release information about a person for legal and law enforcement purposes. Further information about privacy and disclosure of information is available at www.bdm.vic.gov.au ______________________________________________________________________________________________________ Payment Either the applicant mother, applicant father or the adult child for the registration process, must pay the combined statutory fee (addition of registrable information + standard certificate). The fee schedule is available at www.bdm.vic.gov.au. Payment may be made by money order, cheque or credit card. Payments should be made to the Registry of Births, Deaths & Marriages.  MasterCard  VISA Card number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Name of cardholder ______________________________________________ Expiry date _____ / _____ Signature of cardholder ___________________________________________________________________