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Department of Internal Affairs – Te Tari Taiwhenua

BDM405

Authorisation for disclosure of information to agent

Use this form to authorise Births, Deaths and Marriages to dislose information held on the Human Assisted Reproductive Technology Register to an agent, such as a lawyer, acting on your behalf.

Authorisation
I authorise the Registrar-General of Births, Deaths and Marriages to disclose any information to which I am entitled from the Human Assisted Reproductive Technology Register to:
Full name of agent ^
Signed by:
Donor, donor-conceived person or guardian of donor-conceived person ^

Signature ^
Date signed ^
Full name ^

Next Steps 
Print and sign the form. Post to:
New Zealand office:
HART team 
Births, Deaths and Marriages
PO Box 10526
Wellington 6140