BIRTHS, DEATHS AND MARRIAGES
OFFICE OF REGULATORY SERVICES
Justice and Community Safety Directorate

BIRTH REGISTRATION STATEMENT	
Form 201 -BRS	

	Births, Deaths and Marriages Registration Act 1997
Births, Deaths and Marriages Registration  Regulation1998	
WHO IS RESPONSIBLE FOR REGISTRATION
The parent(s) of a child are responsible for having the child’s birth registered, and must sign this form.  The 
Registrar-General will refrain from entering details of a parent who has not signed this form.  In the case of stillbirths the parent(s) may permit hospital staff to complete this form on their behalf; however the parent(s) must still sign the form.  The completed form should be posted or delivered to the address below.  The hospital or medical attendant should complete the birth details section of this form.  	
WHY REGISTRATION IS IMPORTANT
You are required by law to register the birth of a child within 6 months after the date of the birth. It is compulsory to register all live births, and in the case of stillbirths where the child is 400 grams or more or of at least 20 weeks gestation.  If you fail to lodge a birth registration statement, the Registrar-General may register the birth with incomplete information.  The Registrar-General may assign a name to a child if the name stated is a prohibited name or the parents are unable to agree on a name.  It is in the best interests of both the parents and the child that the birth is correctly and completely registered.  If you do not register your child’s birth, you will not be able to obtain a birth certificate for your child.  A standard birth certificate provides legal evidence of age, place of birth and particulars of the parent(s), and may be required for school enrolment, drivers licence, employment and government benefits.  Commemorative certificates are not generally accepted as a legal document. 	
PRIVACY INFORMATION
The Births, Deaths and Marriages registration Act 1997 authorises the Registrar-General to collect the information required by this form.  The Registrar-General prevents any unreasonable intrusion into a person’s privacy in accordance with the Privacy Act 1988 (C’wlth). The Registrar-General may provide identifiable information to law enforcement organisations and authorised organisations that have legal authority to request information under prescribed circumstances. Documents provided as proof of identity may have their authenticity verified through Certificate Validation System (CVS) and the National Document Verification System (DVS). Documents issued by this office may also be verified by external agencies using CVS and/or DVS.	
CONTACT DETAILS	
Send completed forms to the Office of Regulatory Services:	GPO Box 158, Canberra ACT 2601	
Lodge in person at the Office of Regulatory Services:	255 Canberra Avenue, Fyshwick ACT 2609	
Office Hours:	9:00am to 4:30pm Monday to Friday	
General enquiries telephone number:	(02) 6207 3000	
Website address:	www.ors.act.gov.au 
	
INSTRUCTIONS FOR COMPLETION
•	If completing this form by hand please print clearly and use a black pen only.
•	This office will not accept lodgement of this form if it is not completed in full.
•	Any alteration to information provided on this form must be struck through with black pen and substitute information must be clear and both parents if applicable must sign in the margin.  Do not use white out.
•	Traditional cultural naming practices are acceptable however legislation prevents non-English symbols from being entered into the register. 
•	It is not possible to register the birth of a child online.
•	Inaccurate information may delay registration of the birth.
•	A parent is defined in the Legislation Act 2001 as a mother, father or person who is presumed to be a parent under the Parentage Act 2004.

There is no fee to lodge a birth registration statement however a fee is applicable if you require a birth certificate.  For information and forms to apply for a certificate please refer to the certificate order form included in this document or visit our website.	

If you require further information or need advice, a language assistance service is available by phoning the 
Translating and Interpreting Service (TIS) on 13 14 50.	

BIRTH CERTIFICATE ORDER FORM	Application Number		

	
CERTIFICATE APPLICATION INFORMATION	
•	It is not compulsory to order a birth certificate at the time a child is registered.
•	If you order a commemorative package you will also receive a standard birth certificate
•	All certificates sent by mail attract an $8.00 registered person to person postage fee. Please ensure you add this fee to your payment. This service ensures your certificate is protected during delivery and minimises the risk of the certificate being intercepted or stolen.
•	For security purposes the example commemorative certificates below have been altered. Full examples may be viewed in our office. 	

DETAILS OF CHILD	
Surname of Child	Given Name(s) of Child	Date of Birth of Child	
		          /          /	

CERTIFICATE(S) ORDER  - Commemorative Certificates are unable to be used for legal purposes	
For a list of fees for a standard certificate, please refer to the Office of Regulatory Services fee schedule.
 Standard birth certificate                                      Commemorative package                                            Postage 	
TYPES OF COMMEMORATIVE CERTIFICATES 	
	 	  	  	  		  	
 Canberra	      Capital	     Bluebell	 Clowns	 Blue Bunny 
 Pink Bunny	     Bears	      Duck	

DETAILS OF APPLICANT	
Surname	Given Name(s)	
		
Current Residential Address	
	
Daytime Contact Telephone Number	E-mail Address	Signature of Applicant 	
			
Reason Certificate is Required	Relationship to Child Named on Certificate		

POSTAGE DETAILS (All Certificates forwarded by mail attract a $8.00 registered person to person postage fee) 	
Postal Address (	

PAYMENT DETAILS 	
 Visa            Mastercard	Expiry Date	/	Amount	$	
Cardholder Name		Cardholder Signature		
Card Number																				
	
PLEASE NOTE: Payments may be made by cheque, money order or credit card if lodged by post, or also by cash or EFTPOS if lodged in person.   Applications paid by personal cheque will be held for 7-10 working days for the cheque to clear. 	
			
	BIRTHS, DEATHS AND MARRIAGES
OFFICE OF REGULATORY SERVICES
Justice and Community Safety Directorate

BIRTH REGISTRATION STATEMENT	
Form 201 -BRS	

	Births, Deaths and Marriages Registration Act 1997
Births, Deaths and Marriages Registration  Regulation1998	

Certificate applied for?
(Office use only	 Yes       No		Registration Number
(Office use only)		

DETAILS OF CHILD TO BE COMPLETED BY PARENTS  (Any alterations must be signed by all parties)	
Surname/Family Name	Given Name(s)	
		
Sex to be included on birth certificate (please tick one box)	
 Male        Female        Unspecified/indeterminate/intersex        Unspecified        Indeterminate       Intersex		

DETAILS OF CHILD TO BE COMPLETED BY HOSPITAL OR MEDICAL ATTENDANT	
Date of Birth	Time of Birth	Sex of Child (if the sex of the child is known)	If Multiple Birth (i.e. 1 of 2)	

/            /	
am/pm	 Female        Male       
 Unspecified/indeterminate/intersex 	
of	
Weight	Was Child Born Alive	Gestation if Not Alive 	Place of Birth (name of hospital or address if other place)	
grams	 Yes     No	weeks		
Medical Practitioner/s        Registered Nurse/s or Midwife	Other Witnesses Present at the Birth (eg: Father, Friends)	
Dr                                             Rn/Rm		

DETAILS OF MOTHER AT THE TIME OF BIRTH	
Surname/Family Name	Given Name(s)	
		
Former Surname/Maiden Name if Any	Date of Birth	Occupation	
	        /         / 		
Mother’s Place of Birth (suburb/town and state/country)	Residential Address at the Time of the Child’s Birth 	
		
Is the Mother of the Child of Aboriginal or Torres Strait Islander Origin?	
 No      Yes, Aboriginal origin     Yes, Torres Strait Islander origin      Yes, both Aboriginal and Torres Strait Islander origin	
Day time contact telephone number	Signature	
		
DETAILS OF THE  FATHER    PARENT AT THE TIME OF BIRTH (Please indicate whether person is to be known as father or parent)	
Surname/Family Name	Given Name(s)	
		
Former Surname if Any	Date of Birth	Occupation	
	        /         / 		
Father’s Place of Birth (suburb/town and state/country)	Residential Address at the Time of the Child’s Birth 	
		
Is the Father/Parent of the Child of Aboriginal or Torres Strait Islander Origin?	
 No      Yes, Aboriginal origin     Yes, Torres Strait Islander origin      Yes, both Aboriginal and Torres Strait Islander origin	
Daytime Contact Telephone Number	Signature	
		
DETAILS OF PARENT’S RELATIONSHIP (If applicable)	
Are the Parents of the Child in a            Domestic Partnership          Civil Partnership           Married        Civil Union     	
If in a Civil Partnership, Civil Union or Married please complete details below	
Date of Marriage/Endorsement/Declaration	Place of Marriage/Endorsement/Declaration	
             /                /	                                          Suburb/Town                                      State/Country 	
DETAILS OF OTHER CHILDREN OF THIS RELATIONSHIP (List in order of birth including stillborn and adopted children)	
Given Names in Full	Date of Birth	Sex 	Deceased      	Stillborn	
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex 	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
DETAILS OF CHILDREN OF MOTHER NOT OF THIS RELATIONSHIP  (List in order of birth including stillborn and adopted children)	
Given Names in Full	Date of Birth	Sex 	Deceased      	Stillborn	
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
Would you like this information to appear on the birth certificate?	 No   Yes	
DETAILS OF CHILDREN OF FATHER/PARENT NOT OF THIS RELATIONSHIP (List in order of birth including stillborn and adopted children)	
Given Names in Full	Date of Birth	Sex 	Deceased      	Stillborn	
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
	        /        /	 Female    Male
 Unspec/indet/intersex	 No   Yes		
Would you like this information to appear on the birth certificate?	 No   Yes	
DETAILS OF INFORMANT/PARENT COMPLETING THIS FORM	
I certify that I have read this form thoroughly and that the information provided, is to the best of my knowledge and belief, true and correct for registration purposes. I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under Section 11 of the Statutory Declarations Act 1959, and I believe that the statements in the declaration are true in every particular. 

Full name	Occupation 	
		
Full Residential Address	
	
Daytime Telephone Number	Relationship to Child	Signature