Victorian Registry of Births, Deaths and Marriages Births, Deaths and Marriages Registration Act 1996 and Regulations

2008

Application to register a name change (child under 18 years)

Eligibility
To apply to change a childs name in Victoria you must be the parents or guardian of the child. The child: must be under 18 years of age must be born in Victoria If your child was not born in Victoria, you must prove you and your child have been residents in Victoria for the past year (12 months). To change your own name use the form Application to register a name change (adult 18+ years). This form is available at www.bdm.vic.gov.au or at the Registry.

Fees and certicates

A fee of $95.70 must be paid when submitting this form. The fee includes: an application fee of $66.50 (non-refundable) a standard certicate fee of $29.20. If the application is successful, you will receive your childs standard birth certicate which shows the name change, or a change of name certicate (if your child was not born in Victoria). The certicate will be issued in approximately 20 working days, provided your application is complete and you have submitted the required supporting documents. The certicate may be used as proof of your childs name change for legal and other ofcial purposes. Priority service fee An optional priority service is available for a fee of $95.00.  If your application is complete and approved, your childs certicate will be issued within ve working days, instead of the standard 20 working days.  Please note, if your application is incomplete or not approved, the priority fee will not be refunded.

Unsuccessful applications
Your application to change your childs name may be unsuccessful if: there is continuing court action in relation to the name of the child  you fail to disclose information about current and previous names used by the child  the new name is considered to be offensive, too long, includes numbers or symbols without phonetic signicance, resembles an ofcial title or rank recognised in Australia, or is considered to be against the public interest  you do not return all original birth certicates or change of name certicates previously issued to you by the Victorian Registry of Births, Deaths and Marriages  your application is incomplete. Ensure you provide the reason for the name change and the required identity documents for yourself and your child  you do not provide requested information within 28 days of request the Registrar is not satised with the information supplied.

Privacy and disclosure of information

The information requested on this form is collected under the provisions of the Births, Deaths and Marriages Registration Act 1996 and forms the basis of your name change. Information shown on a birth or name change certicate will be based on the information you provide. The Registrar may only release information about a person for legal and law enforcement purposes, in accordance with the provisions of the Act. Further information about privacy, disclosure of data, the Registrys Access Policy and how to correct a record is available at www.bdm.vic.gov.au

Instructions
Write clearly and use blue or black ink and BLOCK letters. Press rmly when writing Do not use correction uid or tape. Keep each number, letter or X within the boxes, for example: Correct Incorrect  If you need to make an alteration, cross out the mistake and have both parents initial the change. Leave answer boxes blank where you have no response or data to enter, for example: Correct Incorrect

Recognising the signicance of life events

Department of Justice
July 2013

Frequently Asked Questions

What type of certicate will my child receive if my application is approved? If your child was born in Victoria, you will be issued with an updated standard birth certicate showing the name change, your childs birth name and any previous names. If your child was not born in Victoria, you will be issued with a change of name certicate. Will any reference be made to my childs former names on certicates? All legal name changes since 31 October 1986 are recorded on the birth register and may appear on any standard birth certicate or name change certicate. I was born overseas and dont have an Australian passport. What documents can I use as proof of my place of birth? You can use one of the following documents: current overseas passport (or expired within the last ve years)  overseas birth certicate (if not in English, you must provide a translation by an accredited translator) travel document Certicate of Evidence of Residence Status (CERS). Please refer to PART FIVE - Proof of identity. Other contacts for assistance: Department of Immigration and Citizenship (DIAC) - call 131 880 Australian Passports - call 131 232. I was born in Australia but not in Victoria, what can I use as proof of my place of birth? You can use the birth certicate issued by the registry in the state or territory you were born in. If the application is unsuccessful will I get a refund? You will be refunded the certicate fee, but not the application fee or priority fee (if applicable).

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My child was not born in Victoria, but currently lives in Victoria. Can I still apply to change my childs name? Yes. However, to change your childs name you must provide proof that you and your child have been living in Victoria for the past year. Please refer to PART FIVE - Proof of identity. What kind of court order can I use to change my childs name without the other parents consent? You can only use an order from the County Court of Victoria, the Family Court or the Federal Magistrates Court. The order must state that your childs current name is to be changed to the new name.

It is best to check with the authority requesting your childs identity documents before you apply to register a name change.

PART OnE - Childs details

1. Current name a) Surname (family name)

PART TwO - Childs proposed new name

Note. The Registrar may refuse to register your childs name change if the new name is obscene, offensive, too long, includes numbers or symbols without phonetic signicance, resembles an ofcial title or rank recognised in Australia, or is considered to be against the public interest. 6. What do you want to change your childs name to? a) Surname (family name)

b) Given name(s)

2. Name at birth (if different from above) a) Surname (family name)

b) Given name(s)

b) Given name(s)

PART ThREE - Parents/Guardians details

3. Date of birth 4. Sex 5. Place of birth a) Suburb/Town Male Female b) Mothers maiden name (surname at birth) 7. Mothers/Guardians details a) Mothers current surname

c) Mothers given name(s)

b) State (or country if born outside Australia)

d) Daytime telephone number

e) Email address

PART ThREE - Parents/guardians details

8. Mothers/Guardians residential address a) Street no. and name

continued

PART FOuR - Supporting information

13. Why are you changing your childs name?

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b) Suburb/Town

Note. You must provide a valid reason in order for this name change application to be considered. Write a brief statement explaining the reason for changing their name. One word explanations such as personal, passport or school are not sufcient and may result in your application being unsuccessful. Please supply any relevant documents to support your application. Reason

c) State 9. Fathers/Parents details a) Fathers/Parents surname (family name)

d) Postcode

b) Fathers/Parents given name(s) 14.  Have you previously changed your childs name (in Australia or overseas) or has your child used other name(s) in the past? No d) Email address  Yes Please provide details below of each name used.  ote. Failure to list all previous names may result in your application N being refused. If there are more names than space allows please attach a separate sheet with the required details. Surname (family name) 1. b) Suburb/Town 2. c) State 11. Are you the only parent on the childs birth record? Yes Go to Q.13 No 12. Are you the sole surviving parent/guardian of the child?  Yes Please supply a certied photocopy of the deceased parents/guardians death certicate. No Go to Q.13 Where changed (Australian state or overseas country) 1. contd How changed (e.g. name change, Deed Poll) 3. d) Postcode Given name(s) Date changed

c) Daytime telephone number

10. Fathers/Parents residential address (if different to mothers) a) Street no. and name

d d / m m /yyyy

d d / m m /yyyy

d d / m m /yyyy

a) Date of death b) Place of death Street no. and name 2. contd

Suburb/Town

3. contd

State (or country if born outside Australia)

15.  Do you have a court order from the County Court of Victoria, the Family Court or the Federal Magistrates Court which states that your childs name be changed? No  Yes  You must submit a copy of the court order. For more information see Frequently Asked Questions on page 2.

c) Death registration number (if known)

PART FIVE - Proof of identity

16. Was your child born in Victoria? Yes  No - Go to Q.18 17. How old is your child? 17.1 My child is under 12 years old Both parents or the guardian must submit: a)  four identity documents in their current name, one from each list below. b)  the original birth certicate of your child. If your child has one or more Victorian birth certicates, you must return them to the Registry. 18. Your child was born outside Victoria (continue below). 19. How old is your child? 19.1 My child is under 12 years old Both parents or the guardian must submit: a)  four identity documents in their current name, one from each list below. b)  one identity document in your childs name from List 1.

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19.2 My child is 12 years old or over Both parents or the guardian must submit: a)  at least four identity documents in their current name, one from each list below. b)  one photo identity document in your childs name from any list below. If you are unable to provide this go to the Photo and signature section on page 5.

17.2 My child is 12 years old or over Both parents or the guardian must submit: a)  four identity documents in their current name, one from each list below. b)  the original birth certicate of your child. If your child has one or more Victorian birth certicates, you must return them to the Registry. c)  one photo identity document in your childs name from any list below. If you are unable to provide this go to the Photo and signature section on page 5. If you are a sole parent or guardian, you need only submit 4 documents of your own and one of your childs.

If you are a sole parent or guardian, you need only submit your own and your childs documents.

LIST 1 Your right to reside in Victoria Birth certicate issued in Australia Australian citizenship certicate  ustralian visa in overseas passport which A authorises residency for 12 months or more LIST 2 Your place of birth/photo and signature

Parent 1

Parent 2

Child

LIST 1 Your right to reside in Victoria Birth certicate issued in Australia Australian citizenship certicate Australian visa in overseas passport which authorises residency for 12 months or more LIST 2 Your photo and signature Australian passport Australian driver licence or learner permit  Australian rearm licence  erticate of Identity (issued by the federal C government for one-time use by Australians travelling overseas)

Parent 1

Parent 2

Child 12yrs+

Parent 1

Parent 2

Child

Parent 1

Parent 2

Child 12yrs+

Australian passport  urrent overseas passport C (or expired within the last ve years) Overseas birth certicate Australian driver licence or learner permit Australian rearm licence  erticate of Identity (issued by the federal C government for one-time use by Australians travelling overseas)  epartment of Immigration and Citizenship D (DIAC) ofcial statement or Certicate of Evidence of Resident Status (CERS) which conrms your place of birth Travel document

If you cannot provide current photo identication from List 2, see Photo and signature section on page 5
LIST 3 Your operation in the community Change of name certicate issued in Australia Marriage certicate (issued by an Australian state or territory registry ofce, not a church or celebrant) Australian divorce papers Credit card or ATM card Student or tertiary identity card Australian security guard or crowd control licence Department of Veterans Affairs card Medicare card Working with Children Check card Deed Poll certicate LIST 4 Your current residential address Utility account (including gas, water, electricity, mobile or home phone) Rates notice Lease or tenancy agreement(s)  ank statement (including savings, credit, B passbook or cheque accounts)
Parent 1 Parent 2 Child 12yrs+ Parent 1 Parent 2 Child 12yrs+

If you cannot provide current photo identication from List 2, see Photo and signature section on page 5
LIST 3 Your operation in the community Change of name certicate issued in Australia  arriage certicate (issued by an Australian M state or territory registry ofce, not a church or celebrant) Australian divorce papers Credit card or ATM card Student or tertiary identity card Australian security guard or crowd control licence Department of Veterans Affairs card Medicare card Working with Children Check card Deed Poll certicate
Parent 1 Parent 2 Child

Continue to Certify your documents section on page 5

continued >

PART FIVE - Proof of identity

continued

PAGE 5

Both parents must provide at least one document from the below list. One parent must prove they have lived in Victoria for at least the last 12 months by providing documents from the below list:

LIST 4 Proof of Victorian residency and current residential address Utility accounts (including gas, water, electricity, mobile or home phone) Rates notices Lease or tenancy agreements Bank statements (including savings, credit, passbook or cheque accounts - must show Victorian transactions)

Parent 1

Parent 2

Certify your documents

Applying by mail? You must mail us photocopies of each identity document certied by a sworn member of police or a Justice of the Peace (JP) located in a police station. Applying in person? You must bring in your original identity documents or photocopies of each identity document certied by a sworn member of police or a JP located in a police station. How to certify your identity documents 1. Make a photocopy of each identity document. 2.  Take your photocopies and the original documents to a police station and ask a sworn member of police or a JP located in a police station to certify them. 3.  Mail us your certied identity documents along with this completed form. Cant make it into Melbourne? You may lodge your application and certify photocopies of your identity documents at selected Justice Service Centres (JSCs). To nd your nearest JSC, visit www.bdm.vic.gov.au/jsc Applying from outside Victoria? If you are applying from other Australian states or territories you may have photocopies of your identity documents certied by a sworn member of police or a Justice of the Peace.

Photo and signature

20. Have both parents supplied photo identity documents (and a photo identity document of the child if 12 years old or over)?  Yes - Go to Part 6, Q.29. No - You must supply certied photographs and signatures. Photograph Professional passport photos are preferred. These are available from most Australia Post outlets, retail photo processing outlets and some chemists. If you are supplying your own photo, it must: be no more than six months old  show only head and top of shoulders  be clear, in focus, of good quality colour, brightness and contrast
45 50mm

Front

 be between 35mm and 40mm wide and between 45mm and 50mm high  be printed on photographic paper, with no marks on the image s  how you without any hat or other head covering

Size

I f you wear a head covering for 35 40mm religious reasons, the photo must show your face from bottom of chin to top of forehead and both edges of your face be attached to this form with a paperclip (do not staple) b  e signed on the back by a Guarantor and include your name and signature. Guarantor You must have a Guarantor endorse your photo. The Guarantor must: not be related to you or your child by birth or marriage n  ot be a domestic partner or in a registered domestic relationship with you Back not live at the same address as you h  ave known you or your child for at least one (1) year be 18 years of age or over.
(applicants full name)

Max 36mm

Min 32mm

All applicants please note:  Do not send original identity documents by mail (except when returning your original Victorian birth and/or change of name certicates).  All documents must be current (except overseas passports) and show current residential address, where applicable.  If your lease or tenancy agreement is more than 12 months old you must provide a letter from your real estate agent which conrms you are a tenant at the same address.  If you supply printed online bank or utility statements they must be stamped and approved by the bank or utility company. The statement must show your name and residential address.  If your identity documents are not in English, you must attach a translation by an accredited translator.  Failure to correctly submit your proof of identity documents will delay your application. If you are unable to meet these requirements, please contact the Registry via www.bdm.vic.gov.au or on 1300 369 367

This is a true photo of

The Guarantor must:  endorse the back of the photo by writing This is a true photo of (the applicants full name) and signing their own name (see illustration at right)  complete and sign the declaration at Q.28.
(applicants signature)

(Guarantors signature)

PART FIVE - Proof of identity

continued

PART SIX - Childs consent

30.  Declaration

continued

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Guarantors details
21. Title Mr Mrs Miss Ms Other 22. Surname (family name)

I consent to my name being changed to the name listed in Part 2 of this form. Note The child must sign this declaration in front of a witness  A witness must be 18 years of age or over and not a parent or legal guardian of the child. a) Childs signature

23. Given name(s)

b) Witness signature

24. Residential address Note. PO Boxes cannot be accepted a) Street no. and name

c) Date

Witness details
31. Residential address a) Street no. and name b) Suburb/Town b) Suburb/Town c) State d) Postcode c) State d) Postcode

25. Date of birth 26. Sex Male Female 27. Daytime phone number 28. Guarantors declaration I declare that the information I have provided is true and correct to my knowledge and that I qualify to be a Guarantor for the person providing their photo for this application. I authorise the Victorian Registry of Births, Deaths and Marriages to make any necessary enquiries with any organisation or individual to verify the information I have provided on this form. a) Guarantors signature

32. Surname (family name)

33. Given name(s)

34. Daytime phone number

PART SEVEn - Declaration

35. Declaration I declare that: the information I have provided in this application is true and correct;  I am the parent or guardian of the child listed on this form and hereby apply to change the childs name to the name listed in Part 2 of this form; The child resides or was born in Victoria; and  I wish for my child to be known by the new name (legal name) stated in Part 2 of this form. I understand that:  this form remains the property of the State of Victoria and that some or all of the information provided may be disclosed to persons or bodies with adequate entitlement to the information under the Births, Deaths and Marriages Registration Act 1996 or the Registrys Access Policy. This includes state and federal government agencies such as Centrelink, State licensing authorities, Department of Immigration and Citizenship (DIAC), and Department of Foreign Affairs and Trade (DFAT);  If my child is not an Australian citizen but has lived in Australia for less than ten years, the Department of Immigration and Citizenship (DIAC) may be notied of the name change;  it is an offence under section 53 of the Births, Deaths and Marriages Registration Act 1996 to knowingly make a false or misleading representation in this application or its supporting documents and that penalties may apply; and the Registry may make enquiries to verify the information I have provided.

b) Date

PART SIX - Childs consent

If your child is 12 years or older, they must consent to the name change unless there are exceptional circumstances. 29. Are there exceptional circumstances why your child cannot give consent? Yes - Please specify below No - Go to Q.35

PART SEVEn - Declaration

continued

PART EIghT - Payment

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I certify that I have read and understood the declaration: Note You must sign the declaration in the presence of a qualied witness  A witness must be a Registry staff member or a person qualied under the Evidence Act 1958 (e.g. Justice of the Peace, a sworn member of police, pharmacist) One person may be the witness for both people signing. a) Mothers/Guardians signature

Fees A fee of $95.70 must be paid when submitting this form. The fee includes:  an application fee of $66.50, which is non-refundable  a standard certicate fee of $29.20. The birth or name change certicate will be issued in 20 working days provided the application is complete, correct, and the required proof of identity and additional documents are supplied. The certicate may be used as proof of your childs name change for legal and other ofcial purposes. Priority service fee An optional priority service is available for a fee of $95.00.  If your application is complete and approved, your certicate will be issued within ve working days, instead of the standard 20 working days.  Please note, if your application is incomplete or not approved, the priority fee will not be refunded. Registered Post, Express Post and International Express Post Standard Australia Post mailing times apply in addition to the above processing times. For details go to www.bdm.vic.gov.au 44. I wish to submit the following payment:
Price* Application and certicate fee $95.70 $95.00 $6.00 $6.50 $16.00 $ $ $ $ Subtotal $95.70 . . . .

b) Witness signature

c) Date

d) Fathers/Parents signature

e) Witness signature

Priority service fee Postage options (standard post is included) Registered Post - (within Australia)

f) Date

Express Post - (within Australia) International Express Post

Witness details
36. Surname (family name)

*All prices listed on this form are subject to change. Current fees may be conrmed at www.bdm.vic.gov.au
45. How do you wish to pay?

Total

37. Given name(s)

By mail Make bank cheques and money orders payable to Registry of Births, Deaths and Marriages Cash payments will only be accepted if you apply in person. Credit - If paying by credit card, please complete card the Credit Card Payment Slip below.

38. Daytime phone number 39. Qualications of witness (e.g. a sworn member of police, Victorian Registry staff member or Justice of the Peace)

Bank cheque

Money order

In person  The Registry accepts cash, credit cards, EFTPOS cards, money orders and bank cheques.

Credit Card Payment (mail applications only)

Witness details (if different)
40. Surname (family name) Card type Total $ 41. Given name(s) Name on card Visa MasterCard Amex

Card number

42. Daytime phone number 43. Qualications of witness (e.g. a sworn member of police, Victorian Registry staff member or Justice of the Peace)

Expiry date Signature of cardholder

If applying by mail, attach certied copies of your identity documents here.

PART EIghT - Payment

46. Please mail the certicate to: My residential address, as per a) Name

continued
Q.8 or Q.10 Other - Provide details below

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b) Street n0. and name

c) Suburb/Town d) State e) Postcode

PART nInE - Lodgement

Submit your form, payment, proof of identity and other supporting documents: By mail Victorian Registry of Births, Deaths and Marriages GPO Box 4332, Melbourne VIC 3001 In person Victorian Registry of Births, Deaths and Marriages Customer Service Centre or Ground oor, 595 Collins St, Melbourne (8.30am 4.00pm, Monday to Friday, except public holidays)

Selected Justice Service Centres (JSCs). To nd your nearest JSC go to www.bdm.vic.gov.au/jsc

Checklist
For your application to be successful, please check that you have met all the following requirements: I am the parent or guardian of the child listed in this form whose name I am changing.  My child is under 18 years of age. My child was born and registered in Victoria (or if living in Victoria but born elsewhere, I have provided evidence  of my and my childs legal entitlement to reside in Victoria). My child currently resides in Victoria and has been residing in Victoria for at least one year. I have disclosed all current and previous name/s my child has used. Both parents have supplied proof of identity documents as requested in Part Five of this form.  I have signed the declaration and had it witnessed by an appropriate person, meeting all requirements in Part Six. I have returned with this application all of my childs original birth or change of name certicates previously issued  by the Victorian Registry of Births, Deaths and Marriages or any other Australian registry. If applying by mail:   I have had the photocopies of my identity documents certied at a Justice Service Centre, by a sworn member of police or a Justice of the Peace located in a police station. I have included payment or completed the Credit Card Payment Slip. After changing your childs name Once your childs name has been changed you must update all ofcial documents and records to show the new name.

Victorian Registry of Births, Deaths and Marriages

General enquiries 1300 369 367 (8.30am 4.30pm, Monday to Friday, except public holidays) Website www.bdm.vic.gov.au

Department of Justice
tHis form is printed on environmentaLLy friendLy paper Using vegetabLe inKs

CONC2013

If you require access to a translation or interpreter service, please contact the Translating and Interpreting Service (TIS) on 13 14 50 and ask them to contact the Victorian Registry of Births, Deaths and Marriages.