BDM400

WESTERN AUSTRALIA
Births, Deaths and Marriages Registration Act 1998

APPLICATION TO REGISTER CHANGE OF NAME

1. WHO CAN APPLY (please note that these are general instructions only)
Change Of Name For An Adult
If you are an adult (18 years and over) you may apply for a change of name if: (a You were born and/or your birth is registered in Western Australia; or ) You are a permanent resident of Australia and are ordinarily a resident in Western Australia; or You are an Australian citizen and are ordinarily a resident in Western Australia (b An adult whose name is being changed must complete Part A. If their spouse or de facto ) partner is also changing their name, then Part B must be completed. (c If born in Western Australia a birth certificate is not necessary, however if born interstate ) a birth certificate must be provided (d If born overseas, your birth certificate and current passport must be provided [also refer ) to point 2(b)]. If you are an Australian citizen, you must also provide your Australian Citizenship Certificate (e Applicants who have changed their name by marriage and are applying for a change of ) name must provide a certified copy of their marriage certificate if married interstate or overseas (f) Proof of any previously registered name change must be provided

Change Of Name For A Child

If you are under 18 years of age and have not been married, your parents may apply to change your name on your behalf if: (a You were born and/or your birth is registered in Western Australia; or ) You are a permanent resident of Australia and are ordinarily a resident in Western Australia; or You are an Australian citizen and are ordinarily a resident in Western Australia (b If both parents are recorded in the childs birth registration, PART C must be completed ) by them unless: An order from the Family Court (telephone 08 9224 8222) is provided with this application; or One parent makes an application and the other parent is deceased. A death certificate must be provided; or Both parents are deceased (death certificates required), cannot be found or for some other reason cannot exercise their parental responsibilities, the childs guardian can apply by completing PART C. Proof of guardianship must be provided (c One parent may apply if they are the sole parent named in the childs birth registration ) complete PART C (d If the child was born in Western Australia a birth certificate is not necessary, however if the child was born interstate or overseas, a full birth certificate recording parents details ) must be provided [also refer to point 2(b)]. If the child has Australian Citizenship, the Citizenship certificate must also be provided (e Proof of any previously registered name change must be provided ) (f) Children aged 12 years or over must also sign the consent section

2. DOCUMENTATION
(a ) (b ) (a ) (b ) Photocopies of original documents will only be accepted if they are certified as a true and correct copy by a Justice of the Peace or a solicitor Overseas documents must be translated into English by an accredited translator Any person whose birth is registered in Western Australia will have the new name noted on their birth registration. An amended birth certificate can be obtained on payment of an additional fee - see page 4 for fees If born interstate, this office will notify the birth state of the name change

3. NOTIFICATION

BDM400

(c ) (a )

Name changes may be notified to other organisations such as the Police Department, Passport Office, Department of Immigration & Citizenship etc Legally married or de facto couples (whether of different or same sex) and sole parents & their children under 18 years of age may apply on one form N.B. Marriage/birth certificate or evidence of de facto relationship must be provided. Refer to page 4. Print clearly. Symbols and abbreviations must not be used Initial all alterations and do not use correction fluid otherwise the form will not be accepted Pay the scheduled fee (see page 4), which includes the issue of a change of name certificate Please allow a minimum of five (5) working days to process your application, plus a further ten (10) working days if paying by personal cheque Faxed application forms will not be accepted

4. COMPLETING THE APPLICATION FORM

(b ) (c ) (d ) (e ) (d ) No te:

You can only change your name once in any 12 month period unless there are exceptional circumstances. This does not apply if you are reverting to your immediate past name It is an offence to make a false or misleading statement in any application or document under the Births, Deaths and Marriages Registration Act 1998 Post to: Registry of Births, Deaths and Marriages OR- Bring the completed form to: Level 10, 141 St Georges Terrace, PO Box 7720 Cloisters Square, PERTH WA 6850 PERTH Office hours: 8.30am to 4.30pm For enquiries 1300 305 021 Web site: www.dotag.wa.gov.au Monday to Friday

PART A ADULT WHOSE NAME IS BEING CHANGED

If born in Western Australia, the change of name will be recorded on your birth registration and will appear on all birth certificates issued after registration of the name change (the Registrar may grant an exemption in exceptional circumstances e.g. Court order, domestic violence). If born Interstate, this office will notify your birth state of your name change.

CURRENT NAME NEW NAME

Surname: Given name(s): Surname: Given name(s):

REASON FOR NAME CHANG PERSONAL DETAILS

Single Married Date of // birth

Defacto Full name at birth

Divorced

Widowed

Separated

State Country

Place of birth:

Town

Yes

If born overseas, are you an Australian citizen? birth certificate/passport) No Residential address Postal address

(attach copy of Citizenship plus

Daytime Telephone Number

P/code

Place of 1st marriage Date of 2nd marriage

P/code

MARRIAGE // Date of 3rd marriage DETAILS

//

Date of 1st marriage

Place of 2nd marriage

Place of 3rd marriage

//

Full name prior to last marriage

Have you previously registered a name change (not including marriage)?

Yes
Date: //

(attach copy)
SIGNATURE

No

PART B SPOUSE / DE FACTO PARTNER

CHANGED)
CURRENT NAME NEW NAME
Surname: Given name(s): Surname: Given name(s):

(IF NAME IS ALSO BEING

REASON FOR NAME CHANG Date PERSONAL DETAILS

of birth

//
Town

Full name at birth

State Country

Place of birth:

Yes

If born overseas, are you an Australian citizen? birth certificate/passport) No

(attach copy of Citizenship plus

MARRIAGE // Date of 3rd marriage DETAILS

//

Date of 1st marriage

Place of 1st marriage

Date of 2nd marriage

Place of 2nd marriage

Place of 3rd marriage

//

Full name prior to last marriage

Have you previously registered a name change (not including marriage)?

Yes
Date: //

(attach copy)
SIGNATURE

No

PART C CHILD WHOSE NAME IS BEING CHANGED (Children aged 12 years or

over must also sign the consent section)

 Please contact the Registry on 1300 305 021 for further advice if:
the child was born in WA, is under 12 months of age and only the given name (s) are to be changed; or the natural parents marry after their childs birth; or the natural fathers details are to be included in the childs birth registration.
If born in Western Australia, the change of name will be recorded on your childs birth registration and will appear on all birth certificates issued after registration of the name change (the Registrar may grant an exemption in exceptional circumstances e.g. Court order, domestic violence). If born Interstate, this office will notify the birth state of your childs name change.

DETAILS OF PERSON/S APPLYING ON BEHALF OF CHILD/REN Mothers name: Fathers name: Relationship to child/ren: Mother Father Parents Guardian
Residential address:

Postal address

P/code

Daytime Tel No.

P/code

REASON FOR NAME CHANGE

CHILD 1
CURRE

Mothers na Fathers na Is this childs name being changed to that of the natural father?
Is this childs name being changed to the mothers latest married name? Place of If yes, date of // marriage Marriage: Consent Mothers signature: t o Natural Fathers signature:

NEW NAME Date of birth Previous name change: (attach copy) No

Surnam e: Surnam e: //
Yes

Given name(s): Given name(s): Place of

birth: Full name at birth:

Yes Yes

No No

Date // Date // Date //

CHILD 2
CURRE

name

Childs signature (if aged 12 or over): Surnam e: Surnam e: //

Yes

Mothers Fathers na na Is this childs name being changed to that of the natural father?
Is this childs name being changed to the mothers latest married name? Place of If yes, date of // marriage Marriage: Consent Mothers signature:

NEW NAME Date of birth Previous name change: (attach copy) No

Given name(s): Given name(s): Place of

birth: Full name at birth:

Yes Yes

No No

Date // Date //

Natural Fathers signature:

Childs signature (if aged 12 or over): a separate list with their details.

Date //

If there are more than 2 children changing their names, please request another form or attach

OFFICE USE ONLY

FEES (Free of GST)

(Prices are subject to change without further notice)
Change of name fee..............................................................................................................................................$156.00 Birth Certificate (Western Australian birth).............................................................................................................$ 44.00

IF YOU HAVE CHANGED YOUR NAME AND WISH TO PURCHASE AN AMENDED BIRTH CERTIFICATE FOR YOURSELF AND/OR CHILD, PLEASE COMPLETE THIS SECTION
Name of person whose certificate you are requesting Date of Birth Birth Certificate Quantity

// // // // // //

or Visa for

PAYMENT DETAILS Enclosed is a cheque/money order for $ OR debit my MasterCard $

Cheques should be made payable to the Registrar of Births, Deaths and Marriages

(NOTE: If paying by personal cheque, please allow an additional 10 working days to process)
Card No. Name of cardholder

Signature of cardholder

Expiry Date

Extract from Section 13A Western relationship and de facto partner

Australian

Interpretation

Act

regarding

de

facto

(1) A reference in a written law to a de facto relationship shall be construed as a reference to a relationship (other than a legal marriage) between 2 persons who live together in a marriage-like relationship. (2) The following factors are indicators of whether or not a de facto relationship exists between 2 persons, but are not essential the length of the relationship between them; whether the 2 persons reside together; the nature and extent of common residence; the degree of financial dependence or interdependence, and any arrangements for financial

support, between them; the ownership, use and acquisition of their property (including property they own individually); whether they care for and support children. (3) It does not matter whether the persons are different sexes or the same sex This information is not exhaustive. If required, please contact the Registry.

Registry of Births, Deaths & Marriages Western Australia

HELP US TO PROTECT YOUR IDENTITY AND REDUCE FRAUD

Identity fraud involving the use of stolen, fictitious or altered identities to perpetrate serious criminal offences is a matter of growing community concern. The Western Australian Registry recognises that certificates and changes of name help to establish a person's identity and is committed to maintaining the security of its information by reducing the risk of certificates being wrongfully issued to people who may use them for fraudulent purposes. Applicants are now required to provide a range of commonly available documents before being eligible to receive certificates or register a change of name. For a childs change of name both parents named on the birth certificate are required to provide identification. When providing information or certificates from records held at the Registry, the Registrar must have regard for the privacy of the person to whom the record relates. For example a birth certificate is usually only available to the person named in the certificate, their parent or legal guardian etc. For further information regarding the access policy, visit our website at www.dotag.wa.gov.au and follow the links or telephone the Registry on 1300 305 021.
If you are applying for a certificate or registering a change of name, you must provide:

ONE form current identification from List 1

OR

of

TWO forms of current identification from List 2

OR

THREE forms of current identification from List 3 plus ONE form of current identification from List 2

If applying in person, original documents must be provided. When applying by post please send clear photocopies of your identification documents with your application.

LIST 1

Identification that has expired, for example a drivers licence, will not be accepted as a form of identification. LIST 2 LIST 3

Australian drivers licence (with photo) Australian firearms licence (with photo) Australian passport Defence force or police service photo identity card Department of Immigration and Citizenship (DIAC) certificate of evidence of residence status (with photo)

Australian drivers licence without photo Centrelink or Department of Veterans Affairs card Citizenship certificate Credit or debit card Current overseas passport with current Australian entry permit DIAC immigration papers Health Care card Medicare card Proof of age card Security guard/crowd control licence Student card Tertiary education student ID card

Bank statement with current residential address Educational certificate/ school report Electricity account with current residential address Gas account with current residential address Motor vehicle registration Shire/water rates Telephone account with current residential address Trade certificate

If you are applying for a certificate on behalf of another person, you must provide the following: Identification for yourself from Lists 1, 2 or 3;

 Identification of the person (from Lists 1, 2 or 3) who is entitled to the document as stated in the Registrys certificate access policy; and A letter giving permission from the person entitled to the document.

10

Registry of Births, Deaths and Marriages Western Australia

PROOF OF RESIDENCY REQUIREMENTS FOR CHANGE OF NAME

Births, Deaths and Marriages Registration Act 1998
If you wish to apply for a change of name in Western Australia and you were not born in the State, to be eligible you must be: a permanent resident of Australia and ordinarily reside in Western Australia; or an Australian citizen and ordinarily reside in Western Australia.

Note: You must provide a minimum of two separate forms of documentary evidence that you have been living or have been ordinarily resident in Western Australia for the three (3) months immediately preceding your application. Evidence of residency must be in the form of documentation that states your current address, such as:

WA drivers licence if photocopy is provided, include both sides; electricity or gas account; shire/water rates; telephone account; or bank statements. Please note:

The Registrar can refuse to register a change of name. The Registry will not accept any papers that do not have a date of issue displayed. Evidence of your current residency can not be older than three months (except your WA photo drivers licence). In extraordinary circumstance the Registry may accept evidence of residency older than three months but not older than six months. You must discuss this with Registry staff before lodging your application.

The Registry may at its discretion conduct checks with appropriate agencies to verify the information in your application including the authenticity of your documentation.

Registrar of Births, Deaths and Marriages Registry of Births, Deaths & Marriages, 141 St Georges Terrace, Perth 6000 Ph: 1300 305 021