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Department of Internal Affairs – Te Tari Taiwhenua

BDM404

Application by donor-conceived person or guardian to access information held on the Human Assisted Reproductive Technology Register

Last updated 24 April 2024

Use this form if you:
• were born as a result of an assisted reproductive procedure performed through a fertility service provider, using sperm, eggs or embryos, and
• want to access information about yourself or your donor held on the Human Assisted Reproductive Technology (HART) Register. 

Part 1: Before you apply

How to submit your application
You can fill out and submit this application form if you are: 
• a donor-conceived person who is aged 18 or older
• a donor-conceived person aged 16 or 17 who has the approval of the Family Court and has attached a copy of the order from the Family Court, or
• a guardian of a donor-conceived person, if the donor-conceived person is under 18 years of age and does not have the approval of the Family Court to complete the form.
Complete and post to:
HART team
Births, Deaths and Marriages
PO Box 1052
Wellington 6140

What you need to provide 
You will need to provide a:
• certified true copy of your photo identity document
• BDM405 Authorisation for Disclosure of Information to Agent form, if the information is being sent to an agent, such as a lawyer, acting on your behalf
• copy of the order from the Family Court, if you are aged 16 or 17. 
Your photo identity document can be your driver licence or the photo page from your passport.
A certified true copy is a photocopy that has been stamped or endorsed by an authorised person. This confirms that the copy is a true copy of the original document. 
An authorised person must be:
• a Justice of the Peace (JP)
• a solicitor or notary public (you may have to pay for their services), or
• a Registrar or Deputy Registrar of the District Court or the High Court, or authorised staff in some government agencies.

Services a counsellor can offer
We recommend that you consult with a counsellor of your choice before submitting this form. 
A counsellor can:
• help you to consider the implications of providing and accessing information
• support you if you contact your donor or a donor-conceived person related to the same donor, if a link is established
• answer questions about how others have approached the issue, and what seems to work best. 
Counselling may be able to be arranged through your fertility service provider, or with an independent counsellor.

Requested information
If the requested information is available on the HART Register, you will receive a printout of the information you request in section 4 of this form. 
The printout will be typed from the registration. A printout is not a legal document.

Part 2: The form

1. Person making application
Yes or no, a donor-conceived person aged 18 years or older ^
Yes or no, a donor-conceived person aged 16 or 17 years, authorised by Family Court 
(attach Family Court order) ^
Yes or no, a donor-conceived person aged under 18 years, for information that does not identify donor ^
Yes or no, a guardian of a donor-conceived person aged under 18 years ^
Yes or no, an agent (for example, a lawyer) acting on behalf of a donor-conceived person or their guardian, 
(attach completed BDM405 Authorisation for disclosure of information to agent form) ^

2. Your details
Current first name(s) of donor-conceived person ^
Current surname of donor-conceived person ^
Donor-conceived person’s date of birth ^
First name(s) of guardian (if guardian is completing the application for donor-conceived child) ^
Surname name of guardian (if guardian is completing the application for donor-conceived child) ^
Fertility service provider (and branch) ^
Fertility service provider identifier (if known) ^

3. Delivery address you would like any information sent to
Street number and name ^
Suburb ^
Town or city ^
Country ^
Postcode ^
Contact phone number ^
Email address ^

4. Information requested 
If your birthdate or the donor’s donation was before 22 August 2005, there may be no information recorded in the HART register because registrations were not mandatory. Restrictions on disclosure of some types of information may apply.
A printout containing all or any of the following: $40.80
Yes or no, information relating to the donor-conceived person who is the subject of the application ^
Yes or no, information relating to the donor(s) of the donor-conceived person ^
Yes or no, information relating to other donor-conceived people related to the same donor ^

A printout containing the following information: $15.30 
(no fee if you have requested with one of the above products)
Yes or no, whether a donor has asked for information about the donor-conceived person ^
Yes or no, whether information is held about the donor(s) of the donor-conceived person ^
Yes or no, whether the donor-conceived person shares a donor with other donor-conceived people ^

Payment section 
Payment
Do not post cash or card. Do not email credit card details.
Charge my credit or debit card (Visa, MasterCard, American Express, Prezzy Card):
Card number ^
Card expiry date ^
Name on card ^
Cardholder signature ^