*** Transcriber's note: Please set your voice synthesiser to read most punctuation. When you encounter the caret sign at the end of a line, please enter the applicable information, if necessary. *** Internal Affairs Te Tari Taiwhenua BDM121 Application to register a name change - Aged 16 and 17 | He tono ki te rēhita i tētahi panoni ingoa - 16 me te 17 tau Use this form to register a name change if you are aged 16 or 17. Before you apply Who can register a name change? To register a name Change in New Zealand: • your birth must be registered in New Zealand, or • if your birth is registered outside New Zealand, you must be a New Zealand citizen or entitled, under the Immigration Act 2009, to be in New Zealand indefinitely (for example, as a permanent resident). Guidelines for your new name Your new name must consist of one surname and one or more other names. If your religious or philosophical beliefs, or cultural traditions require you to only have one name, you will need to attach a letter of explanation. The new name (or combination of names) may not be accepted for registration if it: • might cause offence to a reasonable person • is more than 70 characters long, including spaces, without adequate justification • is, includes, or resembles an official title or rank (in which case attach a letter of explanation), or • is not a name (for example, it must not include numbers or symbols). Timeframe To view our current timeframes for name change, go to: govt.nz/bdmtimeframes If you have requested a certificate showing your new name, allow extra time for postage. If your application is not correct and complete, your application may be delayed. Contact details Website: govt.nz/bdm/contactus Email: bdm.nz@dia.govt.nz Only use email for enquiries about the form. To return the form, follow the postage instructions on page 12. Do not email the completed form to us. True statements If you make, or cause to be made, any false statement or declaration you will be liable, on conviction, to a fine or up to 5 years imprisonment, or both. Requirements You will need to: 1. Have all your guardians sign their consent in section 6 of this form. 2. Provide proof of your eligibility to register a name change in New Zealand (if your birth is registered outside New Zealand). 3. Provide a certified true copy of your current photo identification. 4. Provide proof of your use of your identity of the community. 5. Make a statutory declaration in sections 7-13 of this form. Refer below for further information about these requirements. 1. Guardian consent What is a guardian? A legal guardian is an adult who’s responsible for the upbringing and care of a child. This is often both parents of the child. In some circumstances, it can be one parent or someone additional appointed by the Family Court. You will need all of your guardians to sign this form to show consent to your application to change your name. If you have only one guardian, or any additional guardians, your application will need to include a court document to show them being appointed. For one parent this is usually called a Sole Guardianship Order, or if you have more than two guardians, an Additional Guardianship Order. What if my guardians do not consent? You cannot change your name using this form if you do not have all your guardians’ consent. 2. Your eligibility to register a name change in New Zealand If your birth is registered in New Zealand, you do not need to provide proof of your eligibility to register a name change in New Zealand. If your birth is registered outside New Zealand you must provide evidence of: • the date and place of your birth, and • your status as a New Zealand citizen or entitled, under the Immigration Act 2009, to be in New Zealand indefinitely (for example, as a permanent resident). Provide a certified true copy of one (or combination if applicable) of the following documents: • New Zealand citizenship certificate • New Zealand passport (photo page only) • New Zealand certificate of identity issued under the Passports Act 1992 with a letter/permit/visa from Immigration New Zealand confirming permanent resident status • Australian passport or other evidence of Australian citizenship • Cook Islands, Niue or Tokelau birth certificate • Overseas passport including a resident permit or resident visa issued by Immigration New Zealand • Letter from Immigration New Zealand confirming permanent residence status (only if the letter states your name, date of birth, place of birth and name(s) of parent(s) • Overseas birth certificate together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status • Notarial certificate (China) that includes names of parent(s) together with a letter/permit/visa from Immigration New Zealand confirming permanent residence status • Household/Family census register that includes names of parent(s) from an Asian country together with a letter/ permit/visa from Immigration New Zealand confirming permanent residence status 3. Your current photo identification You must provide a certified true copy of one of the following. It must include your photo. If you are providing a document that has your photo on it as proof of your eligibility to register a name change in New Zealand, this will also serve as your photo identification. • New Zealand or overseas passport (photo page only) • New Zealand or overseas school photo ID • New Zealand or international driver licence (copy of front and back) • Overseas identity card A certified true copy is a photocopy that has been stamped or endorsed by an authorised person. For example, a solicitor/lawyer, notary public, registrar of the court or Justice of the Peace. This confirms that the copy is a true copy of the original document. If you do not have photo identification, you will also need to fill out an Identity Referee Declaration form (BDM76) and attach it to this application. You can find this form at: govt.nz/name-change-adult You must present your current photo identification or completed BDM76 form (with attached photo) to the person authorised to take a statutory declaration when you sign the declaration in front of them. They can certify your document at the same time. 4. Proof of identity in the community You must provide two documents from different sources. These do not need to be certified true copies. For example: • Student or tertiary identity card • Educational certificate or school report • Trade certificate • Community Services Card • Bank statements (including savings, credit or cheque accounts) • Inland Revenue tax number (provide an IR card or statement) 5. Statutory declaration requirements A statutory declaration is a written statement signed in front of an authorised person and declared to be true. The people below are authorised to take a statutory declaration. In New Zealand • Registrar of Births, Deaths and Marriages • Justice of the Peace • Registrar or a deputy registrar of the Supreme Court, Court of Appeal, High Court or a District Court • Person enrolled as a barrister and solicitor of the High Court • Any other person authorised by law to administer an oath om a Commonwealth country other than New Zealand • Commonwealth representative • Justice of the Peace • Notary Public • Judge • Commissioner of Oaths • Solicitor of the High Court of New Zealand • A person authorised by law to administer an oath for the purpose of judicial proceeding (examples below) Non-Commonwealth country • Commonwealth representative • Notary public • Judge • Solicitor of the High Court of New Zealand Examples of people authorised by the law of Australia, England, Wales, Ireland, Northern Ireland and Scotland to administer an oath for the purpose of judicial proceeding: Australia Australian Police are not authorised to take this statutory declaration unless you are in the Northern Territory. Australian pharmacists, optometrists and doctors are not authorised to take statutory declarations. • Judge • Notary public • Justice of the Peace • Solicitor of the High Court of New Zealand • Australian legal practitioner • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative Also, if in Northern Territory • Commissioner for Oaths (by personal appointment) • Member of the Legislative Assembly • Member of the house of the Parliament of the Commonwealth elected to represent the Territory or a constituency in the Territory • Member of the police force who is 18 years or older Also, if in Queensland • Commissioner for Declarations • Conveyancer Also, if in South Australia • Commissioner for Affidavits Also, if in Western Australia • A mining registrar appointed under the Mining Act 1978 England or Wales • Judge • Commissioner of Oaths (by personal appointment) • Notary public • Justice of the Peace • Solicitor of the High Court of New Zealand • Solicitor • Barrister • Legal executive • Licensed conveyancer • Court clerk or registrar who certifies their authority to take an oath for a judicial proceeding • Commonwealth representative Ireland or Northern Ireland • Judge. • Solicitor. • Notary Public. • Justice of the Peace. • Court clerk or registrar who certifies his or her authority to take an oath for a judicial proceeding. • Commonwealth representative. • Solicitor of the High Court of New Zealand. Scotland • Judge. • Notary Public. • Justice of the Peace. • Person authorised by the law of that country to administer an oath for the purpose of a judicial proceeding. • Commonwealth representative. • Solicitor of the High Court of New Zealand. Privacy statement The information provided on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 2021 (the ‘BDMRR’ Act). A person who makes, or causes to be made, a false declaration on this form will be liable on conviction to a fine or term of imprisonment, or both. The new information will be held on a public register, and may generally be accessed by any person on application (e.g. as a certificate or printout). The Department of Internal Affairs may also release it to certain government agencies and foreign registration authorities, as authorised by law. This form, the accompanying certificate, and the details relating to your sex at birth will not be publicly available, except where the Registrar-General is satisfied the information is required in relation to the administration of an estate or trust, a marriage, or by order of a Court. A new birth registration will be made from the information provided. Corrections may be made as provided for in the BDMRRR Act. The BDMRR Act governs access to registered information. Information about your rights to access and, where appropriate, correct the information is available on our website govt.nz/bdm or freephone 0800 22 52 52. Fees statement All fees are correct as at the form version date. All fees are in New Zealand dollars. How to answer: • You can complete this form by hand or on-screen using Adobe Reader. • You can use the Tab key to move to the next fillable form field in Adobe Reader. • You must still print off the application and sign where applicable by hand. Please read the ‘Before you apply’ section of this application form carefully before you start. If your application is not correct and complete, your application may be delayed or unsuccessful. Form begins. 1. My name 1a. Name at birth. This is the name on your birth certificate. All first and middle names ^ Surname ^ 1b. Name from previously registered name change (if applicable). This applies if your current name is different from your name at birth due to a registered name change. All first and middle names ^ Surname ^ 2. My date of birth. Date of birth (DD/MM/YYYY) ^ 3. My place of birth. Town or city ^ Country ^ 4. My contact details. Phone number ^ Email ^ My preferred name for contact purposes ^ 5. Indicate whether you want your attached documents to be: Securely destroyed Yes or No ^ Returned to you Yes or No ^ 6. Guardian consent All of your guardians must sign. I/we are the guardian(s) of the person whose registered name is to be changed and I/we consent to the change as set out in this application by the applicant. Guardian 1’s full name ^ Guardian 1 signature ^ Date signed (dd/mm/yyyy) ^ Guardian 2’s full name (if applicable) ^ Guardian 2 signature Date signed (dd/mm/yyyy) Guardian 3’s full name (if applicable) ^ Guardian 3’s signature ^ Date signed (dd/mm/yyyy) ^ Guardian 4’s full name (if applicable) ^ Guardian 4’s signature ^ Date signed (dd/mm/yyyy) ^ The next section is the Statutory Declaration. You will need to sign it in front of an authorised person. Refer to the start of this document for the list of people authorised to take a Statutory Declaration. Statutory declaration Take care completing this statutory declaration as you may be required to do it again if there are errors. All corrections must be: • initialled • dated, and • witnessed by a person authorised to take a statutory declaration. 7. I, (enter the name you are currently known by) Full name ^ 8. of (enter your residential address. This cannot be a PO Box) Street number and name ^ Suburb ^ Town or city ^ Country ^ 9a.Enter your occupation, for example, ‘Student’ or ‘Landscape gardener’. If you have no occupation, enter ‘No occupation’. Occupation ^ Solemnly and sincerely declare that: I authorise any necessary additional enquiries including the disclosure of personal information about myself for the purpose of determining eligibility for this name change application. My authorisation includes any information held by the Department of Internal Affairs or another NZ government agency. 10. The name I want to register is: Refer to the ‘Guidelines for your new name’ at the start of this document. All first and middle names ^ Surname ^ 11. I advise that I intend to use my new name once my name is registered Yes or no ^ If you are already using your new name select this. 12. Fill out and sign this section before a person authorised to take a statutory declaration. (Refer to the start of this document for the list of authorised people.) And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957. Declared at (town or city, and country) ^ this day of (dd/mm/yyyy) ^ by (Signature of applicant) ^ 13. The person authorised to take a statutory declaration must complete this section. I am satisfied of the applicant’s identity because (select one): I have sighted the applicant’s original photo identification document from the list at the start of this form (write document name and number below). Yes or No ^ Document name (e.g. New Zealand passport) ^ Document number (e.g. Passport number) ^ I have sighted the applicant’s photo on a fully completed BDM76 Identity Referee form. Yes or No ^ Signature (Authorised person signs here) ^ Full name of authorised person ^ Qualification of authorised person ^ 14. Human Assisted Reproductive Technology Register (HART) Are you a person born as a result of a HART procedure? Yes Yes or No ^ Fill in this section. No Yes or No ^ Go to Section 15. This section applies if you were born as a result of an assisted reproductive technology procedure using donated sperm, eggs or embryos through a fertility clinic. If the information has been provided to Births, Deaths and Marriages for inclusion on the HART Register, it will be updated to include your new name. This means that up-to-date information will be provided to persons who are authorised to access your information under the Human Assisted Reproductive Technology Act 2004. Donation made after 21 August 2004. If your birth occurred as a result of a donation made after 21 August 2004, information will be sent to a fertility clinic. We can send information about the name change to the fertility clinic. They can then update their records. Yes, I consent to my new name being sent to the fertility clinic named below that holds the information: Fertility clinic name ^ 15. Fees. The application fee to register a name change is $170. If your birth is registered in New Zealand, you can also order a birth certificate that shows your new name. If your birth is registered outside New Zealand, you can also order a name change certificate that shows your new name. 16. Birth certificate (additional fee). You can order a birth certificate if : • your birth is registered in New Zealand, and • you need a certificate that shows your new name. If you do not need a certificate to prove your new name, this is optional. There are several types and packages of birth certificate that you can select from. Standard certificate. $33 each. Quantity wanted? ^ Forest style decorative certificate. $35 each. Quantity wanted? ^ Beach style decorative certificate. $35 each. Quantity wanted? ^ Two certificate package: beach style decorative and one standard. $55 per package. Quantity wanted? ^ Two certificate package: forest style decorative and standard. $55 per package. Quantity wanted? ^ 17. Name change certificate (additional fee). You can order a name change certificate if: • your birth is registered outside New Zealand, and • you need a certificate that shows your new name. If you do not need a certificate to prove your new name, this is optional. Name change certificate. $33 each. Quantity wanted? ^ 18. Delivery of birth or name change certificate (additional fee). If you have ordered a birth or name certificate, select a delivery method: I want the certificate(s) sent by standard post, which costs $0 Yes or No ^ I want the certificate(s) couriered to a New Zealand address for $5 Yes or No ^ I want the certificate(s) couriered to an overseas address for $15 to $30 Yes or No ^ Australia, Asia, Pacific courier costs $15. USA courier costs $20. Rest of world (icludes: Azerbaijan, Armenia, Bulgaria, Bosnia and Herzegovina, Cyprus, Croatia, Greece, Georgia, Macedonia, Malta, Moldova) costs $30. Contact us if you are unsure whether we can deliver to your country. Delivery address: Delivery name (this can be any name you prefer) ^ Street number and name ^ Suburb ^ Town or city ^ Country ^ Postcode ^ 19. Payment Do not post cash or card. Do not email credit card details. Charge my debit or credit card (Visa, MasterCard, American Express, Prezzy Card): Visa Yes or No ^ Mastercard Yes or No ^ AMEX Yes or No ^ Prezzy Card Yes or No ^ (a) Card Number. ^ (b) Expiry Date. (MM/YY) ^ (c) Cardholder's name. ^ (d) Cardholder's signature. ^ Next steps. Print and sign the form. Post the form, appropriate fee(s), and documents to us. Postal address: Births, Deaths and Marriages Department of Internal Affairs PO Box 10-526 Wellington 6140 New Zealand Sydney office: Births, Deaths and Marriages Department of Internal Affairs GPO Box 365 Sydney New South Wales 2001 Australia London office: Births, Deaths and Marriages Department of Internal Affairs 1 Pall Mall East London SW1Y 5AU United Kingdom Last updated 5 September 2024.