*** 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 BDM132 Request, reinstate or withdraw a non-disclosure direction. Notes. Non-disclosure direction. A non-disclosure direction may be requested to be placed on a person’s records if the person (i.e. the subject of the record), or his or her personal representative (refer next page for description), reasonably believes that disclosure of the registered information, or any part of the registered information, would be prejudicial to the personal safety of that person or his or her family. A non-disclosure direction expires after 5 years unless it is reinstated or withdrawn. A non-disclosure direction may be requested to be reinstated for further periods of 5 years if the circumstances relating to personal safety continue to exist. Births, Deaths and Marriages will not contact you if the non-disclosure direction is about to expire. It is the responsibility of the subject or his or her personal representative to request a reinstatement of a non-disclosure direction. If a non-disclosure direction is in place on a person’s record(s), generally only the person who is the subject of the information, their personal representative, or an authorised government department may access registered information on the record(s). If any other person attempts to access registered information when a non-disclosure direction is in place they will be advised that the information exists but that the information cannot be provided. Details about active non-disclosure directions may be shared with authorised government departments to enable them to provide additional safeguards to your information. There is no fee to request, reinstate or withdraw a non-disclosure direction. This application is to place a non-disclosure direction on birth, name change, marriage and civil union records held within Births, Deaths and Marriages. You are recommended to contact other agencies and/or organisations directly to find out how they use and store your personal information. Request or reinstate a non-disclosure direction. To request a non-disclosure direction or a reinstatement of a non-disclosure direction you must complete this form (BDM132), a General Identity Declaration form (BDM130), and any additional documentation as required if you are the person’s personal representative. You must also provide one or more of the following as a certified true copy or original document: Protection order that is in force under the Family Violence Act 2018. Restraining order that is in force under the Harassment Act 1997. Police report or statutory declaration from a member of the Police to the effect that he or she believes that your personal safety, or that of your families, could be prejudiced by the disclosure of your registered information. Letter from either a Barrister or Solicitor, your employer, a Registered Medical Doctor, a Justice of the Peace, or the like, supporting your application on the grounds that your personal safety, or that of your families, could be prejudiced by the disclosure of your registered information. Statutory Declaration stating the facts and some other evidence that satisfies the Registrar-General that your personal safety, or that of your families, could be prejudiced by the disclosure of your registered information. Withdraw a non-disclosure direction. To withdraw a non-disclosure direction you must complete this form (BDM132), a General Identity Declaration form (BDM130), and any additional documentation as required if you are the person’s personal representative. Notes continued. Personal Representative. A “personal representative” means: • a person who has been granted a power of attorney or has been given written authority by the subject of the record, if the subject has attained the age of 18 years or has earlier married or entered into a civil union or de facto relationship; or • if the subject of the non-disclosure has died, the executor, administrator, or trustee of the deceased person’s estate. Documents the personal representative must provide (if applicable). If the personal representative is a parent or guardian of the subject of the record and the subject’s birth information is registered in New Zealand: State this in a signed letter. If the personal representative is a parent or guardian of the subject of the record and the subject’s birth information is registered outside New Zealand: Provide a certified true copy of the child’s birth certificate, which must name the parents (include a translation if not in English). If the personal representative is a parent or guardian of the subject of the record and was appointed a testamentary guardian by a deceased parent under section 26(2) of the Care of Children Act 2004 or section 7(2) of the Guardianship Act 1968: Provide a certified true copy of the deed or will. If the personal representative is a parent or guardian of the subject of the record and is a Court appointed/approved guardian: Provide a certified true copy of the Court appointment/approval. If the personal representative has been granted a power of attorney or has been given written authority by the subject of the record, attach a certified true copy of the power of attorney; or written authority. Information made public while non-disclosure direction in force. If you have a non-disclosure direction in force on your registered information and you make any part of your information, or any information corresponding to that part of the information, publicly available then any person may request that Births, Deaths and Marriages verify whether the information that has become publicly available matches, or is consistent with, the relevant registered information. To contact us. Visit our website www.bdm.govt.nz Freephone 0800 22 52 52 (New Zealand only). If overseas phone + 64 9 339 0852 Email bdm.nz@dia.govt.nz Post this completed and signed form, with attachments to: Births, Deaths and Marriages PO Box 10-526 Wellington 6140 New Zealand. Privacy. The information on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 2021. As part of processing your request for a Births, Deaths and Marriages product or service, your identification details may be checked against other records held by Births, Deaths and Marriages or other government agencies, as authorised by law. Despite a non-disclosure direction being in place on your record(s), certain agencies and persons may access the records for certain, limited purposes. Details about active non-disclosure directions maybe shared with authorised government departments to enable them to provide additional safeguards to your information. Internal Affairs Te Tari Taiwhenua. BDM132 Request, reinstate or withdraw a non-disclosure direction. Attach General Identity Declaration form (BDM 130). Please print clearly. Please initial any alterations. Applicant to complete and sign. Applicant’s full name. First and middle names ^ Surname or family name ^ Applicant’s Address. Addressee ^ Flat number, street number and name ^ Suburb or rural locality ^ City or town ^ Postcode ^ Country (if not New Zealand) ^ Entitlement. I am entitled to request, reinstate or withdraw the non-disclosure direction because: I am the subject of birth, marriage, civil union and/or name change information Yes or No ^ or I am the personal representative of the person who is the subject of the birth, marriage, civil union and/or name change information (Refer to Notes above) Yes or No ^ Action requested. I request the following action be taken (tick one of the following): Place a non-disclosure direction on the information. Yes or No ^ or The non-disclosure direction already in place be reinstated. Yes or No ^ or Withdraw the non-disclosure direction. Yes or No ^ Attach documentation (as required). 1. A General Identity Declaration form (BDM130) must be fully completed, signed and attached to this form. 2. Documentation that satisfies the Registrar-General that your personal safety may be at risk. 3. If you are the person’s personal representative you are required to provide additional documentation (Refer to notes above). Applicant’s signature. ^ Date (DD/MM/YYYY) ^ Applicant’s email address. ^ Applicant's daytime mobile or phone number. ^ On the following pages indicate the subject’s applicable records. Registered information affected by this request. Subject’s birth record. Subject’s full name. First or given names ^ Surname or family name ^ Subject's full name at birth (if different from above). First or given names ^ Surname or family name ^ Subject's date of birth (DD/MM/YYYY) ^ Subject's place of Birth. City or town ^ Country (if not New Zealand) ^ Birth records of child(ren) of subject. Child one's first and middle names. First or given names ^ Child one's surname or family name. Surname or family name ^ Child one's first and middle names at birth (if different from above). First or given names ^ Child one's surname or family name at birth (if different from above). ^ Child's date of birth (DD/MM/YYYY) ^ Child’s place of birth. City or town ^ Country (if not New Zealand) ^ Child two's first and middle names. First or given names ^ Child two's surname or family name. Surname or family name ^ Child two's first and middle names at birth (if different from above). First or given names ^ Child two's surname or family name at birth (if different from above). ^ Child's date of birth (DD/MM/YYYY) ^ Child’s place of birth. City or town ^ Country (if not New Zealand) ^ Child three's first and middle names. First or given names ^ Child three's surname or family name. Surname or family name ^ Child three's first and middle names at birth (if different from above). First or given names ^ Child three's surname or family name at birth (if different from above). ^ Child's date of birth (DD/MM/YYYY) ^ Child’s place of birth. City or town ^ Country (if not New Zealand) ^ Child four's first and middle names. First or given names ^ Child four's surname or family name. Surname or family name ^ Child four's first and middle names at birth (if different from above). First or given names ^ Child four's surname or family name at birth (if different from above). ^ Child's date of birth (DD/MM/YYYY) ^ Child’s place of birth. City or town ^ Country (if not New Zealand) ^ Registered information affected by this request (continued). Subject’s death record. Subject’s first and middle names. First or given names ^ Subject’s surname or family name. Surname or family name ^ Subject's date of death (DD/MM/YYYY) ^ Subject's place of death. City or town ^ Country (if not New Zealand) ^ Subject’s name change record. Subject’s first and middle names. First or given names ^ Subject’s surname or family name. Surname or family name ^ Subject’s first and middle names at birth (if different from above). First or given names ^ Subject’s surname or family name at birth (if different from above). Surname or family name ^ Subject's date of birth (DD/MM/YYYY) ^ Subject's place of birth. City or town ^ Country (if not New Zealand) ^ Subject’s marriage record(s). Most recent marriage. Date of marriage (DD/MM/YYYY) ^ Place of marriage. City or town ^ Country (if not New Zealand) ^ Marriage partner’s first and middle names. First or given names ^ Marriage partner’s surname or family name. Surname or family name ^ Previous marriage 1. Date of marriage (DD/MM/YYYY) ^ Place of marriage. City or town ^ Country (if not New Zealand) ^ Marriage partner’s first and middle names. First or given names ^ Marriage partner’s surname or family name. Surname or family name ^ Previous marriage 2. Date of marriage (DD/MM/YYYY) ^ Place of marriage. City or town ^ Country (if not New Zealand) ^ Marriage partner’s first and middle names. First or given names ^ Marriage partner’s surname or family name. Surname or family name ^ Subject’s civil union records. Most recent civil union. Date of civil union (DD/MM/YYYY) ^ Place of civil union. City or town ^ Civil union partner’s first and middle names. First or given names ^ Civil union partner’s surname or family name. Surname or family name ^ Previous Civil Union 1. Date of Civil Union (DD/MM/YYYY) ^ Place of Civil Union. City or town ^ Civil union partner’s first and middle names. First or given names ^ Civil union partner’s surname or family name. Surname or family name ^ Previous Civil Union 2. Date of Civil Union (DD/MM/YYYY) ^ Place of Civil Union. City or town ^ Civil union partner’s first and middle names. First or given names ^ Civil union partner’s surname or family name. Surname or family name ^ Note: Continue on a separate page if necessary. Internal Affairs Te Tari Taiwhenua. BDM130 General Identity Declaration. Reference number, if known ^ Warning. It is an offence, punishable by imprisonment and/or a fine of up to $10,000, to make a false statement to obtain a certificate, printout or a source document, or to provide any means of identification knowing that it is false or is suspected to be forged or falsified. It is an offence to make any statement that is false for the purpose of the recording information under the Births, Deaths, Marriages, and Relationships Registration Act 2021. Instructions. If you have any questions or you are unsure about how to complete this form please contact us. • Within New Zealand Freephone 0800 22 52 52 • Outside New Zealand phone +64 4 463 9362 1. The applicant must fully complete both Parts A and B. 2. Part C must be completed by any other person 16 years of age or older. Part A. My Details (as the applicant). Current name. Surname ^ First names ^ Name at birth (if different from above). Surname at birth (if different from above) ^ First names at birth (if different from above) ^ Place and Date of birth. Place of birth (town or city), including country if not New Zealand ^ Date of birth (DD/MM/YYYY) ^ Your daytime phone number (daytime) ^ Your email address ^ Part B. My declaration (the applicant must complete). I declare that the information about me that is entered on this form is true and correct. Signature ^ Date signed (DD/MM/YYYY) ^ If applying on behalf of a company state their name below and include an original signed request on letterhead. Your details or the company name may be entered in the Access Register. ^ For information about the Access Register visit www.bdm.govt.nz Part C. Referee’s declaration (any other person 16 years of age or older must complete). I am 16 years of age or older and have known the applicant for at least 6 months or have seen a government issued photo identification of the applicant and I am satisfied the information about the applicant’s identity stated in this form is true and correct. Signature of referee. ^ Full name of referee. ^ Date signed. (DD/MM/YYYY) ^ Phone number of referee. ^ Contact address of referee. ^ Privacy Statement. The information on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 2021. As part of processing your request for a Births, Deaths and Marriages product or service, your identification details may be checked against other records held by Births, Deaths and Marriages or other government agencies, as authorised by law. Last updated 15 June 2023.