Application to Register Change of Name - 18 years or over

Births Deaths and Marriages
Phone (03) 6233 3793
Email BDM@justice.tas.gov.au
Web www.justice.tas.gov.au/BDM
Application to Register
Change of Name - 18 years or over
BDM Product Code CNR
OFFICE USE ONLY
Registration no
Control no
HOW TO APPLY FOR A CHANGE OF NAME
To change your name you must complete this form, pay the fee and provide documentation to support your application.
You must provide evidence of your right to reside in Australia, identity, proof of Tasmanian residency and previous changes of
name. If you cannot provide the identification documents listed below, please contact Births, Deaths and Marriages on
(03) 6233 3795 or email bdm@justice.tas.gov.au.
Identification must be certified:
All identification must be certified by a Justice of the Peace or by a Births, Deaths and Marriages staff member only. To find your
nearest Justice of the Peace please contact the Legal Aid Commission on 1300 366 611.
In Person:
If you are applying in person at the Hobart Births, Deaths and Marriages Registry, you will need to make an appointment by
phoning (03) 6233 3795.
By Post:
Send the form with your cheque, money order or credit card details to:
Births, Deaths and Marriages,
GPO Box 198, Hobart, Tasmania, 7001.
Please do not send original documents.
Born in Tasmania:
If you were born in Tasmania, the Change of Name will be noted on your birth record. If you forward your original birth certificate
with the application, an updated version will be sent to you with the Change of Name Certificate.
Born interstate:
If you were born interstate and require a copy of the amended birth certificate you will need to contact the State or Territory
where you were born.
Overseas Applicants:
Overseas applicants must pay by credit card or bank draft in Australian dollars.
Overseas documents must be translated into English by an accredited translator.
Overseas documents must be certified by a Notary Public. A Notary Public can be found at an Australian consulate. For more
information refer to the Department of Foreign Affairs and Trade, www.dfat.gov.au.
Enquiries:
For processing times and details about who can apply please see our website - www.justice.tas.gov.au/bdm or email
BDM@justice.tas.gov.au.
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NEW NAME
Surname
Given Name/s
CURRENT NAME (name you are using now)
Surname
Given Name/s
NAME AT BIRTH
Surname
Given Name/s
DETAILS OF BIRTH
Place of Birth: State Country
Date of Birth: Gender Male Female
DETAILS OF PARENTS (as at time of birth)
Father's Name
Mother's Name
REASON FOR NAME CHANGE (Reason must be specific eg "personal" is not acceptable)
Before a change of name can be registered, you must supply a valid reason for the change. Births, Deaths and Marriages are
required by law to ensure that any change of name is not for fraudulent or improper purposes.
Examples of valid reasons for name change include:
- Required to support an application with another government agency eg Passports Office
- To formalise the use of an assumed name eg married overseas.
Reason for name
change
PREVIOUS NAMES Please list all names you have previously had and the date changed.
If you have legally changed your name you will need to provide a copy of your change of name certificate or your marriage
certificate.
If you did not legally change your name, Births, Deaths and Marriages may contact you to provide a statutory declaration.
Previous Name Place Changed Date Changed
Previous Name Place Changed Date Changed
Previous Name Place Changed Date Changed
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RIGHT TO RESIDE IN AUSTRALIA
If you were born in Australia, you must provide your birth certificate as part of this application.
If you were not born in Australia, please provide at least one (1) document from the list below.
Australian citizenship certificate
Australian Passport
Australian visa and overseas passport
IDENTIFICATION
Please note any document you provide must not be expired. It must also be issued in the name you are currently using.
Provide two (2) current documents from the list below, at least one showing your signature.
Australian Photo Driver Licence
Australian Passport
Social Security Benefits Entitlement card
Proof of Age card
Defence Force or Police Service photo ID card
Medicare card
Credit card, account card, passbook account statement
Student ID card
PROOF OF TASMANIAN RESIDENCY
Were you born outside of Tasmania? No Yes
If yes, you will need to provide one (1) document from the list below which shows at least 12 months residency in Tasmania.
Bank Statements
Lease or tenancy agreements
Rates notice
Utility accounts (including gas, water, electricity, mobile or home phone)
Department of Taxation Group/Advice certificate
Centrelink issued Health Care card
DECLARATION
I, (Current Name)
Of (Residential Address)
declare I wish to be known by the name of:
New name
I declare that the statements made in this application are true and correct. I do solemnly and sincerely declare that the new name will be used by
me for all purposes in the future and is not sought for fraudulent or improper purposes. My old name(s) will not be used and I understand that I
cannot register for a change of name within any Registry in Australia in the next 12 months. I understand that some or all of the information
provided on this form, and the documents submitted as Proof of Identity, may be disclosed to and / or verified with law enforcement agencies,
other Registries and Commonwealth agencies.
Signature of applicant
Date signed
Before me
JP Number
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Signature of JP
Date signed
If you knowingly provide false information in this declaration, you may be guilty of an offence under Section 54 of the Births, Deaths and Marriages
Registration Act 1999.
PAYMENT DETAILS
Please include with your application a cheque or money order made payable to Births, Deaths and
Marriages. Alternatively, please complete the credit card authorisation below.
Credit Card Type Visa Mastercard
Card Number Expiry date /
Cardholder Name Amount ($):
Signature
Date signed
POSTAL DETAILS
If you require the certificate to be posted to a different address to the one above state the persons name and address below:
Postal Address
Suburb State Pcode
Country
Email
Work Home Mobile
Your certificate will be sent by standard mail. If you wish to pay for postage please indicate below:
Registered Post
Express Post
PERSONAL INFORMATION PROTECTION STATEMENT
In line with the Personal Information Protection Act 2004, the Registry of Births, Deaths and Marriages is collecting this information so that it can determine your eligibility to obtain the
requested certificate and to prevent fraud. If you do not provide all of the information requested, particularly that relating to the reason the document is required and your relationship to
the registered person, then you may not be provided with a copy of the certificate. Your personal information may be disclosed to law enforcement agencies, courts and other
organisations authorised to collect it.
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