REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES ACT 1961

Registration of Births, Deaths and Marriages Act Regulations 1963

These regulations were repealed by the Births, Death and Marriages Registration Act 1998 s. 71(2) (No. 39 of 1998) as at 14 Apr 1999 (see s. 2 and Gazette 9 Apr 1999 p. 1433).

 

 

Registration of Births, Deaths and Marriages Act Regulations 1963

Contents

1.Citation1

2.Revocation1

3.Interpretation1

4.Directions in forms2

5.Fees2

6.Information papers2

7.Register to be kept2

8.Fees to be paid to certain district registrars and assistant district registrars3

9.Discretion as to completing form4

10.Prescribed period of gestation and weight (section 3)4

12.Registration of birth by authority of a Judge5

13.Registrations under Adoption of Children Act 18965

14.Application to confer, change or add name5

15.Application relating to lawful change of name or lawful assumption of name6

16.Entry in register of name of father of illegitimate child6

16A. Request under section 21A (2) of the Act6

16B. Request under section 21A (3) of the Act6

16C. Application under section 73A of the Act7

16D. Prescribed ethnic groups, religious customs and naming procedures7

16E. Prescribed day7

17.Entry of disposal of body previously delivered to school of anatomy7

19.Information concerning the legitimation of a child8

20.Time for giving information of legitimation of child8

21.Information paper as to birth of legitimated child signed by one parent only8

22.Registration of birth of legitimated child born out of the State9

23.Form of statutory declaration10

24.Application for registration of birth of legitimated child under s.55 of the Act10

25.Form of particulars of orders or decrees of dissolution or nullity of marriage10

26.Penalty for offences10

1st Schedule

2nd Schedule

3rd Schedule

Notes

Compilation table36

 

REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES ACT 1961

Registration of Births, Deaths and Marriages Act Regulations 1963

1.Citation

These regulations may be cited as the Registration of Births, Deaths and Marriages Act Regulations 1963.

2.Revocation

The regulations made under the Registration of Births, Deaths, and Marriages Act 1894, are revoked.

3.Interpretation

(1)In these regulations, unless the contrary intention appears — 

“legitimated child” or “legitimated person” means a child or person legitimated by virtue of Part VI of the Marriage Act 1961, of the Parliament of the Commonwealth;

“registration” used in relation to a birth, death, marriage, or any document means registration of the birth, death, marriage or document under the Act;

(2)Unless the contrary intention appears, expressions used in these regulations have the same respective meanings as in the Act.

(3)In these regulations a reference to a schedule by number shall be read as a reference to the schedule so numbered in these regulations, and a reference to a form by number shall be read as a reference to the form as so numbered in the Second Schedule.

[Regulation 3 amended by Gazette 24 January 1986 p.259.]

4.Directions in forms

A form prescribed by these regulations shall be completed in accordance with such directions as are specified in the form as so prescribed.

5.Fees

The fees set out in the second column of the First Schedule are the fees prescribed in respect of the matters in the first column opposite to which they are set out.

6.Information papers

An information paper required to be given pursuant to the Act relating — 

(a)to a birth, shall be completed and furnished in accordance with Form No. 1;

(b)to a death, shall be completed and furnished in accordance with Form No. 2.

7.Register to be kept

(1)An assistant district registrar shall keep a register in accordance with Form No. 3 and he shall record therein particulars of each birth and each death in respect of which he has received an information paper in the prescribed form.

(2)The assistant district registrar shall — 

(a)insert in the appropriate place provided in each such information paper the date the paper was first received by him;

(b)endorse the paper with his signature; and

(c)forthwith thereafter forward the paper and supporting documents, if any, to the district registrar for the registry district in which the birth or the death, to which the paper relates, occurred.

(3)The assistant district registrar shall, as soon as possible after the end of each month, complete and forward to the district registrar of the relevant registry district, a summary of all births and deaths recorded in the register kept by him during that month, as having occurred in that registry district.

8.Fees to be paid to certain district registrars and assistant district registrars

(1)This regulations applies to any person who is not a salaried officer under the Public Service Act 1904, and who acts in the capacity of a district registrar or an assistant district registrar.

(2)Where the person acts as district registrar — 

(a)all fees received by him from members of the public in accordance with these regulations, except as provided in this regulation, shall be paid to the Treasurer of the State for the State;

[(b)Deleted by Gazette 30 December 1983 p.5029.]

(c)he is entitled to retain for his own use all fees paid under Part IV of the First Schedule received by him from members of the public, except fees so paid for — 

(i)correction of an entry in a register;

(ii)a document incorporating the result of a search.

(iii)the entry of a change of name on a registration; and

(iv)the entry conferring, adding to, or changing the first name of a child on a registration; and

(d)he is entitled to retain for his own use the marriage fee prescribed by the Marriage Regulations made under the Marriage Act 1961, of the Parliament of the Commonwealth.

(3)Where the Registrar General waives a fee that would otherwise have been paid under these regulations and retained by a district registrar in accordance with this regulation, the district registrar shall be paid by the Registrar General the amount of the fee so waived.

(4)Where the person referred to in subregulation (1) of this regulation acts as assistant district registrar he shall transmit to the relevant district registrar all fees received by him under the First Schedule.

[Regulation 8 amended by Gazettes 10 January 1966 p.57; 20 August 1971 p.3072; 30 December 1983 p.5029.]

9.Discretion as to completing form

A person completing a form prescribed by these regulations or by the Act shall, where it is hand written, complete it by writing clearly in black or blue­black iron‑gall ink of good permanence and shall not blot the writing before the permanency of the writing is ensured.

10.Prescribed period of gestation and weight (section 3)

(1)For the purposes of the definition of “birth” or “birth of a child” in section 3 of the Act — 

(a)the prescribed period of gestation is not less than 20 weeks, measured as commencing on the first day of the mother’s last menstrual period and continuing for the intrauterine life of the live foetus; and

(b)the prescribed weight is not less than 400 grams.

(2)For the purposes of this regulation, the Registrar General may — 

(a)obtain an estimate from the medical practitioner, or midwife, attending the mother as to the gestation period;

(b)act on an estimation under paragraph (a) when determining whether a birth should be registered.

(3)Where an estimation of the gestation period under this regulation cannot be made, or is inconclusive in relation to the prescribed gestation period under subregulation (1) (a), the prescribed weight shall be the sole criterion used for determining whether a “birth” or “birth of a child” (other than a live birth) has taken place for the purposes of the Act.

[Regulation 10 inserted by Gazette 28 December 1990 pp.6370‑1.]

[11. Revoked by Gazette 10 January 1966 p.57.]

12.Registration of birth by authority of a Judge

Where a Judge of the Supreme Court has authorised the registration of a birth, the Registrar General on receipt of the authority of the Judge shall register that birth, and may require the applicant for the authority or his agent to complete and furnish a prescribed information paper in respect of the birth.

[Regulation 12 inserted by Gazette 10 January 1966 p.57.]

13.Registrations under Adoption of Children Act 1896

(1)Where, in pursuance of section 13 of the Adoption of Children Act 1896, an application is made to the Registrar General for the re‑registration of the birth of a child, the applicant shall furnish particulars in accordance with Form No. 4.

(2)A re‑registration of birth made under that section shall be in accordance with Form No. 5.

14.Application to confer, change or add name

(1)Where an application is made under subsection (1) of section 29 of the Act to have the first or christian name of a child conferred, changed or added to, the application shall be made to the Registrar General in writing.

(2)Where such an application purports to be made by any of the persons referred to in subsection (2) of section 29 of the Act, the Registrar General may require the person to produce to him evidence establishing that the person is qualified to make the application under that subsection.

15.Application relating to lawful change of name or lawful assumption of name

Where an application is made pursuant to section 30 of the Act, to have an entry made in a registration with respect to the lawful change of a name or the lawful assumption of a name, the application shall be in accordance with Form No. 6.

16.Entry in register of name of father of illegitimate child

(1)An entry in a register of the name of, or any other particulars relating to the father of a child, authorised pursuant to subsection (3) of section 21 of the Act, shall be made in the margin of the registration and shall be signed by the Registrar General or by the appropriate district registrar.

(2)A statutory declaration required to be furnished pursuant to subsection (2) of section 29 of the Act shall be in accordance with Form No. 7.

16A. Request under section 21A (2) of the Act

A request to the Registrar General under section 21A (2) of the Act shall be made in accordance with Form No. 11 in the Second Schedule.

[Regulation 16A inserted by Gazette 24 January 1986 p.259.]

16B. Request under section 21A (3) of the Act

A request to the Registrar General under section 21A (3) of the Act shall be made in accordance with Form No. 12 in the Second Schedule.

[Regulation 16B inserted by Gazette 24 January 1986 p.259.]

16C. Application under section 73A of the Act

An application under section 73A (1) of the Act shall be in accordance with Form No. 13 in the Second Schedule.

[Regulation 16C inserted by Gazette 24 January 1986 p.259.]

16D. Prescribed ethnic groups, religious customs and naming procedures

For the purposes of section 21A (3) of the Act — 

(a)an ethnic group set forth in column 1 of the Third Schedule is a prescribed ethnic group; and

(b)the religious custom or naming procedure set forth against that ethnic group in column 2 of the Third Schedule is prescribed for that ethnic group.

[Regulation 16D inserted by Gazette 24 January 1986 p.259.]

16E. Prescribed day

For the purposes of section 73A of the Act the day set forth in column 3 of the Third Schedule against an ethnic group is the prescribed day for that ethnic group.

[Regulation 16E inserted by Gazette 24 January 1986 p.259.]

17.Entry of disposal of body previously delivered to school of anatomy

When, after the delivery to a school of anatomy of the body of a person whose death has been registered, the body is buried, cremated or otherwise disposed of, and a certificate in accordance with the form of the Fifth Schedule to the Act in respect of the body is given to the district registrar for the registry district in which the death occurred, an entry referring to the burial, cremation or other disposal shall be made in the margin of the registration, and that entry shall be signed by the Registrar General or that district registrar.

[18. Revoked by Gazette 10 January 1966 p.57.]

19.Information concerning the legitimation of a child

Information of the legitimation by virtue of Part VI of the Marriage Act 1961, of the Parliament of the Commonwealth, of a child born in the State shall be given to the Registrar General pursuant to section 51 of the Act in accordance with the form of the prescribed birth information paper, namely Form No. 1, which shall be signed by both parents of the child as informants, or if one of those parents is dead, by the surviving parent.

20.Time for giving information of legitimation of child

(1)The information referred to in regulation 19 shall be given to the Registrar General — 

(a)within three months of the date of the marriage of the parents of the legitimated child, if they were married after the date of the coming into operation of the Marriage Act 1961, of the Parliament of the Commonwealth; or

(b)within six months after that date, if the marriage of the parents of the legitimated child took place before that date.

(2)Notwithstanding that the information is not given in accordance with subregulation (1) of this regulation the Registrar General may in his discretion accept the information for the purposes of Part VI of the Act.

21.Information paper as to birth of legitimated child signed by one parent only

(1)Where the prescribed birth information paper relating to the birth of a legitimated child is signed by one parent of the child only, the birth of the legitimated child shall not be registered unless — 

(a)particulars of the father have already been entered in the register in accordance with section 21 of the Act or the father has acknowledged paternity by signing the register at the time the birth of the child was first registered; or

(b)evidence is produced to the Registrar General that an affiliation order against the father has been made by a court of competent jurisdiction in respect of the child; or

(c)there is produced to the Registrar General an order declaring the child to be legitimate, made by the Supreme Court of a State or Territory of the Commonwealth, or a certified copy of the order.

(2)The parent furnishing the information paper shall furnish to the Registrar General, if he so requires, a certified copy of the registration of the marriage of the parents of the child, or such other evidence of that marriage as the Registrar General requires.

(3)The parent furnishing the information paper shall furnish such other evidence as to the legitimation of the child as the Registrar General requires.

22.Registration of birth of legitimated child born out of the State

(1)Application to the Registrar General for registration of the birth of a legitimated child not born in the State but domiciled therein, pursuant to section 52 of the Act, shall be made in accordance with Form No. 8 by the parents of the child or if one of those parents is dead, by the surviving parent, or by a person who has obtained an Order of a Court under section 92 of the Marriage Act 1961, of the Parliament of the Commonwealth declaring the child to be a legitimated child.

(2)The applicant shall complete and furnish to the Registrar General a prescribed birth information paper in accordance with Form No. 1 in respect of the child.

(3)The applicant shall furnish to the Registrar General such evidence as he may require as to the birth and the legitimacy of the child and to the marriage of the parents.

23.Form of statutory declaration

Where the Registrar General requests that a statutory declaration be made under section 53 of the Act, the statutory declaration shall be made in accordance with Form No. 9.

24.Application for registration of birth of legitimated child under s.55 of the Act

(1)Application for the registration of the birth of a legitimated person born in the State, pursuant to section 55 of the Act shall be made to the Registrar General in accordance with Form No. 10.

(2)The applicant shall furnish such evidence as the Registrar General may require as to the birth and legitimacy of the person whose birth is required to be registered and to the marriage of the parents of that person.

25.Form of particulars of orders or decrees of dissolution or nullity of marriage

The particulars of an order or decree of dissolution of a marriage or of nullity of a marriage shall, pursuant to section 49 of the Act, be furnished in accordance with Form No. 11.

26.Penalty for offences

A person who commits an offence against these regulations is liable to a penalty of forty dollars.

[Regulation 26 amended by Gazette 20 August 1971 p.3072.]

 

1st Schedule

PART I — BIRTHS

On notification of a birth to a District Registrar or to an Assistant District Registrar —

(a)Within 60 days from date of birth, or arrival of a child under 18 months in the State

 

Free

(b)After 60 days and within 12 months of date of birth or arrival in the State

 

Free

(c)After 12 months from date of birth or arrival of the child in the State

 

30.00

 

PART II — DEATHS

On notification of a death to a District Registrar or to an Assistant District Registrar — 

(a)Within 14 days of date of death or the finding of the body

Free

(b)After 14 days and within 12 months of the death or the finding of the body

 

30.00

(c)After 12 months from date of death or finding of the body, for each year or part thereof

 

10.00

 

PART III — MARRIAGES

On notification of a marriage to a District Registrar — 

(a)Within 14 days of date of marriage

Free

(b)After 14 days from date of marriage

30.00

 

PART IV — MISCELLANEOUS

 

$

(a)For correction of an entry in a register…………………

30.00

(b)For a search in an index over any period not exceeding 5 years. ………………………………………………..

 

12.00

(c)For a document incorporating the result of a search ……..

12.00

(d)For a certified copy of a registration (including a search over any period not exceeding 5 years) …………………

 

27.00

(da)For a certified copy of a registration of a birth, death or marriage at least 60 years old, when the registration number and registration district are provided ……………

 

 

17.00

(e)For an extract of an entry in a Register of Births issued other than on the occasion of the registration of a birth (including a search over any period not exceeding 5 years) …………………………………………………..

 

 

 

27.00

(f)For an extract of an entry in a Register of Deaths or a Register of Marriages (including a search over any period not exceeding 5 years) ………………………………….

 

 

25.00

(g)For the registration of a name pursuant to section 29 of the Act ……………………………………………………

 

Free

(h)For an entry of a change of name referred to in section 30 of the Act ………………………………………………..

 

Free

(i)For the re‑registration of a birth as provided in section 13 of the Adoption of Children Act 1896 ……………………

 

Free

(j)For giving priority to the issue of a certified copy of a registration, in addition to any other fee ………………

 

17.00

(k)For a microfiche set containing consolidated birth, death and marriage index records:

1841 – 1905 ……………………………………………..

 

 

 

140.00

(l)For a compact disc containing birth, death and marriage index records:

1841 – 1905 …………………………………………….

 

 

205.00

(m)For a microfiche set containing death index records:

1906 – 1953 ……………………………………………

 

100.00

1954 – 1965 ……………………………………………

35.00

1966 – 1970 ……………………………………………

20.00

1971 – 1980 ……………………………………………

40.00

(n)For a microfiche set containing marriage index records:

1906 – 1930 ……………………………………………

 

35.00

1931 – 1953 ……………………………………………

55.00

1954 – 1965 ……………………………………………

35.00

[First Schedule inserted by Gazette 20 August 1971 p.3072; amended in Gazettes 27 June 1980 p.1941; 28 October 1983 p.4371; 11 January 1985 p.178; 31 October 1986 p.4040; 3 July 1987 p.2560; 15 July 1988 p.2450; 21 July 1989 p.2217; 2 August 1991 p.3993; 23 June 1992 p.2634; 6 August 1993 p.4275; 24 June 1994 p.2881; 30 December 1994 p.7346; 5 August 1997 p.4446; 30 June 1998 p.3545.]

2nd Schedule

Form No. 1

Western Australia

(Registration of Births, Deaths and Marriages Act 1961)

BIRTH INFORMATION PAPER

Item 1

Regn. Number……………..

(IMPORTANT — Handwriting on this paper should he done with a

black or blue‑black iron‑gall ink of GOOD PERMANENCE.)

 

 

Item

Child

2.(1)Date of Birth (in words NOT figures)…………….…day of ………………..19……..

 

(2)Place of Birth (Precise Address required)……………………………………………..

 

(3)Name of Child (block letters):

 

Full Christian Names ………………………………………………………………

 

or equivalent)

 

Surname……………..………………………………………………………………

 

If twins or triplets, state whether “1st born,” and “2nd born,” etc…………………….

 

(4)Sex……….Weight of Child at Birth……………….grammes

 

Was child born alive……………If not, state period of gestation.

Father

3.(1)Name of Father (block letters):

of Child

Full Christian Names ………………………………………………………………….

 

(or equivalent)

Surname ……………………………………………………………………………….

 

(2)Usual Occupation…………………. (3) Age (last Birthday)………………………..

 

(4)Birthplace (Town)…………………..(State and/or Country)…………………………

Marriage

of Child’s

Parents;

and

Previous

Issue of

such

Marriage

4.(1)Date of Marriage. . . . . . . . . . . . . . . . . . . . . 19. . . . . . . .

(2)Place of Marriage (Town, State and/or Country). . . . . . . . . . . . . . . . . . . .

(3)Previous Issue of above Marriage (including children legitimated thereby) in order of Birth. (Please state full Christian (or equivalent) Names of both living and deceased Children. In the case of deceased Issue, enter the word “Deceased” in lieu of Age. If unnamed, so describe, and state sex): — 

 

Christian or

(equivalent)

Names of

previous

Children

Age Last

Birthday,

or “Deceased”

Christian or

(equivalent)

Names of previous

Children

Age Last

Birthday,

or “Deceased”

 

 

Other Issue of Mother (i.e., any Children NOT of present Marriage) — 

 

No. of Males…………………….No. of Females……………………….

Mother

of Child

5.(1)Name of Mother (block letters):

Full Christian Names (or equivalent)………………………………………………..

 

Surname when Child was Born……………….(2) Maiden Surname………………

 

(3)Age (last Birthday)…………………………………………………………………..

 

(4)Birthplace (Town) …………………..(State and/or Country) ……………………...

 

Name of Municipality in which Mother usually resides…………………………….

(City/Town/Shire) (Strike out whichever is inapplicable.)

Witnesses

to birth

6.(1)Name of Accoucheur (Doctor or Midwife)…………………………………………

(2)Name of Nurse………………………………………………………………………

 

(3)Names of other Witnesses of Birth………………………………………………….

 

(4)Name of Occupier of Place where Child was Born…………………………………

 

DECLARATION BY INFORMANT

Informant

(should

be Father

or Mother

if at all

prac

ticable)

7.(3)I, the undersigned, (name in full) …………………………………………………...

(2)Residing at (full address)……………………………………………………………

(1)being the (see Footnote (a))……………………………..of the Child mentioned in Item 2 above do solemnly and sincerely declare that the particulars given in this Paper are true to the best of my knowledge and belief. And I make this solemn declaration knowing that by the Criminal Code I am liable, in case of falsehood, to imprisonment with hard labour for three years.

To Sign

here

Witness to

Signature

Signature of Informant……………………………………………………………..

Declared at……………………..this…………………day of…………………….19……..

Before me (Signature of Witness)……………………………………….(if practicable one of the persons mentioned in Item 6 above should sign as Witness) of (Address of Witness)………………………………………………………………………………….

 

Received by Assistant D.R. at………………………..on ………………………19……..

 

Signature of Assistant District Registrar ………………………………………………….

 

Received by District Registrar at …………………….on ………………………19……..

 

Signature of District Registrar…………………………………………………………….

Registrar

8.(1)Registered on……………………….19……………………(2) at Perth.

 

(3)Signature of Registration Officer …………………………………………………...

 

(a)Here state “Father” or “Mother”. If impracticable for Father or Mother to act as Informant, “Occupier of place of birth” should be the Informant.

Form No. 2

Western Australia

(Registration of Births, Deaths and Marriages Act 1961)

DEATH INFORMATION PAPER

Item 1

Regn. Number……………..

(IMPORTANT — Handwriting on this paper should be done with a

black or blue‑black iron‑gall ink of GOOD PERMANENCE.)

Deceased

Person

2.(1)Name (Block { Full Christian Names (or

letters){ equivalent)……………………………………………………..

{ Surname………………………………………………………..

(2)Usual Occupation……………………………………………………………………

 

(3)Late Residence (usual address)……………………………………………………...

 

In……………………….City, Town, Shire (strike‑out whichever is inapplicable).

 

(4)Sex…………………….Age…………………………….

 

3.(1)Date of Death …………………………day of…………………………..19………

 

(2)Place of Death (precise address required)…………………………………………..

 

4.(1)Cause of Death — For details see { Medical Certificate attached.

(Strike out whichever is{ Form to be furnished by

inapplicable). Coroner.

 

(2)Medical Practitioner by whom certified…………………………………………….

 

(3)Date he last saw Deceased alive…………………………………………………….

 

5.(1)Birthplace (town and country)………………………………………………………

 

(2)Years lived in each Australian State (to be named)…………………………………

 

6.(1)Father’s Name{ Full Christian Names (or equivalent)………………………

 

(Block letters){ Surname…………………………………………………….

 

(2)Father’s usual occupation …………………………………………………………...

 

(3)Mother’s Name{ Full Christian Names (or equivalent)……………………...

 

(Block letters){ Maiden Surname…………………………………………..

 

7.(1)State whether deceased was Single, Married, Widowed or Divorced………………

Details of First Marriage

Details of Subsequent Marriages

(2) Place ……………………..

………………………………………...

(3) Date………………………

………………………………………...

(4) To whom ………………...

………………………………………..

 

(5)Names and ages of children of deceased in order of birth. (Please state full christian (or equivalent) Dames of both living and deceased children. In the case of deceased children, enter the word “Deceased” in lieu of age. If unnamed, so describe, and state sex): — 

 

Christian (or

equivalent)

names only

Age last

Birthday,or

“Deceased”

Christian (or

equivalent)

Names only

Age Last

Birthday,

or “Deceased”

 

 

Was deceased in receipt of (state Yes or No): — (a) Age or Invalid Pension…………………..

(b) Widow’s Pension …………………(c) Child Endowment…………………………………

(d) War Pension…………………………………………………………………………………

Disposal of Body

8.(1)Date of Burial or Cremation (state which) …………………………………………

(2)Place of Burial or Cremation ………………………Portion of ……………………

 

Cemetery; or Crematorium at……………………………………………………….

 

(3)Name of person who certified to disposal of body………………………………….

 

(4)Name of certifying crematorium official……………………………………………

 

(5)Officiating Minister’s Name………………………………………………………...

 

(6)Religious Denomination…………………………………………………………….

 

(7)Names of Witnesses to Burial or depositing of body at Crematorium

 

DECLARATION BY INFORMANT

Informant

9.(3)I, the undersigned, (name in full)……………………………………………………

 

(2)of (full address) ……………………………………………………………………..

 

(1)(description — see Footnote (a))……………………………….. being one of the persons required by law to give information to the District Registrar concerning the death of the abovementioned deceased person, do solemnly and sincerely declare that the particulars given in this paper are true to the best of my knowledge and belief. And I make this solemn declaration knowing that by the Criminal Code I am liable, in case of falsehood, to imprisonment with hard labour for three years.

To Sign

here

Signature of Informant……………………………………………………………...

Witness to

Signature

Declared at………………… this…………………day of………………..19……..

Before me (Signature of Witness) ………………………………………………….

 

of (Address of Witness)…………………………………………………………….

 

Received by Assistant D.R. at ……………….…on………………….…19……..

 

Signature of Assistant District Registrar …………………………………………

 

Received by District Registrar at ………………on……………………….19……..

 

Signature of District Registrar ……………………………………………………..

Registrar

10.(1)Registered on……………………………..19……….(2) at Perth.

 

(3)Signature of Registration Officer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(a)The informant must be either the “Person disposing of the Body” or the “Occupier of the Place” wherein the death occurred, e.g., Funeral Director, Matron of Hospital, etc.

Form No. 3

RECORD OF BIRTH AND DEATH INFORMATION PAPERS

RECEIVED BY THE ASSISTANT DISTRICT REGISTRAR…………………

Date

Received

Birth or

Death

Date of

Event

Place of

Event

Name of

Child or

Deceased

Person

Name of Informant

Address of Informant

Posted to District Registrar

aton

 

 

 

 

 

 

 

 

 

 

FORM No. 4

Regulation 13

Registration of Births, Deaths and Marriages Act 1961.

ADOPTION

INFORMATION CARD FOR RE‑ REGISTRATION OF BIRTH

(Pursuant to Section 13 of Adoption of Children Act 1896)

No……………………………..

The Child was born on the…………………..day of………………….., 19……..

At…………………………………………………………………………………

Full Christian Name and Surname of Child……………………………………...

(Block letters)

……………………………………………………………………………………

Sex of child……………………………………………………………………….

Full christian Name and Surname of Adopting Father…………………………...

……………………………………………………………………………………

Full Christian Name and Surname of Adopting Mother…………………………

Address of Residence of Adopting Parents………………………………………

Date and Number of Order of Adoption………………………………………….

Address of Applicant……………………………………………………………..

……………………………………………………………………………………

Date of Application………………………………………………………………

Full Name of Applicant (to be subscribed by Applicant)………………………..

Date and Place of Registration…………………………………………………..

Signature and Title of Registrar………………………………………………….

Form No. 5

BIRTH IN THE STATE OF WESTERN AUSTRALIA

REGISTERED BY…………………………….

Column

1.

REGISTRATION NUMBER

2.

CHILD

 

When and where Born

 

Christian Name and

 

Surname

 

Sex

3.

PARENTS

 

Name of Father

 

Name of Mother

 

Address of Residence

4.

When and Where

Registered

Signature and Title of

Registrar

 

 

Form No. 6

Western Australia

Registration of Births, Deaths and Marriages Act 1961

CHANGE OR ASSUMPTION OF NAME

Any person whose birth or marriage is registered in Western Australia, and who has lawfully changed his or her name or has lawfully assumed a name since such registration, may apply to the REGISTRAR GENERAL to have an entry referring to such change or assumption of name made in either or both of the registers of births and marriages.

Any person to whom this provision applies is urged to take advantage of it without delay by forwarding to the Registrar General, Perth, the following: — 

1.The subjoined application form duly completed and supported by,

a.The License or Deed Poll duly registered by the Registrar of Deeds

or

b.A certified copy of either document, issued by the Registrar of Deeds

or

if the lawful assumption of name occurred by usage

c.Documentary evidence thereof or a Statutory Declaration to that effect.

2.A fee of $1.00 for each entry.

Note:Change of or assumption of a surname by a woman on or after marriage cannot be entered in her birth registration.

(Address)…………………………………..

(Date)……………………….

THE REGISTRAR GENERAL,

Cathedral Avenue, PERTH, W.A.

Sir,

Whereas (a)……………………………………………………………………

(See footnote)

has lawfully assumed the name of………………………………………………..

……………………………………………………………………………………

I now request that an entry referring to such change or assumption of name be made in the margin of the Registration of

{ I.the birth of the said (a)……………………………………………...

{who was born onat………………………..

{and whose parents’ names were (father)…………………………….

*{and (mother)………………………………………………………...

{ II.the marriage of the said (a)………………………………………….

{who was married to…………………………………………………

{aton………………………………….

The fee of……………………………..is enclosed (see Note 2 in instructions above) together with the Deed Poll, License, Statutory Declaration. (Cross out whichever is inapplicable.)

Yours faithfully,

………………………………………….

Signature of Applicant

Note:(a)Here state name in full prior to assumption of new name.

 

 

FOR OFFICE USE ONLY

 { If entry required on

 { registration of birth only,

 { complete Section 1.

Registration No……………………………..

Receipt No. and Date…………………………..

*{If entry required on

 { registration of marriage

 { only, complete Section II.

Entered by and Date……………………………

Indexed to year……………….by……………...

 { If entry required on

 { registrations of birth

 { and marriage, complete

 { both Sections I and II.

Date D.R. advised……………………………..

Checked by and Date ………………………….

Form No. 7

Western Australia

Registration of Births, Deaths and Marriages Act 1961

(Section 21)

FOR OFFICE USE ONLY

Registration No……………………………..

Receipt No. and Date………………………

Entered by and Date……………………….

Indexed to Year………………by……………….

Date D.R. Advised………………………..

Checked by and Date………………………….

DECLARATION

I, ………………………………………………………………………………of

………………………………………………………………………employed as

………………………………………………………..do solemnly and sincerely

(state usual occupation)

declare that: — 

1.I was born at………………………..on………………………………….

2.I am the father of a child named….………………………………………

………………………………….………………………………………...

born to………………………….…………………………………………

on the…………………………..day of…………………………19……..

at…………………………………………………………………………...

3.I desire that the relevant particulars relating to me as the father of the said child be entered in the registration of the birth of the child.

And I make this solemn declaration by virtue of Section 106 of the Evidence Act 1906.

Signature………………………………………………

Declared at………………………..this……………….day of…………………...

19……..before me

…………………………………….J.P.*

(or as the case may be)

DECLARATION TO BE MADE BY MOTHER IF BIRTH OF CHILD PREVIOUSLY REGISTERED

I, …………………………………………………………………………………

of …………………………………………………………the mother of the child

……………………………………………………………………………………

solemnly and sincerely declare that I desire the relevant particulars relating to

……………………………………………………………………………………

who is the father of the said child, be entered in the registration of the birth of the Child.

And I make this solemn declaration by virtue of Section 106 of the Evidence Act 1906.

………………………………………..

Declared before me at……………this…………..day of……….………19……..

…………………………………………J.P. *

(or as the case may be)

* This Declaration may be made before any of the following persons: Justice of the Peace, Town Clerk, Secretary to a Shire, Electoral Registrar, Postmaster, Classified Officer in the State or Commonwealth Public Service, Classified State School Teacher, or a member of the Police Force.

Form No. 8

Western Australia

Registration of Births, Deaths and Marriages Act 1961

APPLICATION UNDER SECTION 52 TO REGISTER THE BIRTH OF A LEGITIMATED CHILD DOMICILED IN BUT NOT BORN IN WESTERN AUSTRALIA

To the REGISTRAR GENERAL.

1.I/We……………………………………………………………………….

of…………………………………………………the mother of the child

being *……………………………..of…………………………………….

(child’s full name)

……………………………………………………………………………..

who is domiciled in the State of Western Australia and who was born at

……………………………………………………………………………..

on…………………………………...and who has been legitimated by our marriage at ……………………..…….on…………………………………

pursuant to Section……………………...of the Marriage Act 1961, of the Parliament of the Commonwealth, hereby apply to have the birth of the said…………………………………………………………………………

registered pursuant to Section 52 of the Registration of Births, Deaths and Marriages Act 1961.

2.The birth of the said……………………………………………………….

……………………..was previously registered at………………………...

(If not previously registered, state why not.)………………………………

……………………………………………………………………………..

3.I/We attach the following documents: — 

(strike out any not applicable)

A.Certified Copy of the registration of the birth of…………………...

………………………………………………………………………

B.Certified Copy of the Registration of our marriage.

C.Statement as to father’s domicile at time of marriage.

D.A prescribed Birth Information Paper duly completed.

E.A statutory declaration of paternity by the father of………………..

………………………………………………………………………

F.Order of a Court under Section 92 of the Marriage Act 1961, of the Parliament of the Commonwealth.

*Description of applicant, e.g., Parents, Father, Mother, Guardian, etc.

(Signature)………………………………………

FOR OFFICE USE ONLY

Registration No …………………………………….

Receipt No. and Date……………………………….

Entered by and Date………………………………..

Indexed to Year…………………by………………..

Date D.R. Advised………………………………….

Checked by and Date……………………………….

Form No. 9

Western Australia

Registration of Births, Deaths and Marriages Act 1961

(Part VI, Section 53)

Declaration

I, (1)………………………………………………………………………………

of (2)………………………………., (3)…………………………………………

do solemnly and sincerely declare that: — 

 1. I am the father of a child named………………………………………….

……………………………………………………………………………………

born on the………………………………day of……………………….19……..

at………………………………………………………………………………….

 2. I was married to…………………………………………………………...

the mother of the said child on the…………………..day of ……………………. 19…….., at……………………………………………………………………….

and am desirous of having the birth of the said child registered as the lawful issue of myself and the said………………………………………………………

 And I make this solemn declaration by virtue of section one hundred and six of the Evidence Act 1906.

Signature…………………………………………

Declared at…………………….the………………….day of…………………….

19……., before me

……………………………………J.P.*

(or as the case may be)

(1) Name in full

(2) Address

(3) Occupation

*This Declaration may be made before any of the following persons: — Justice of the Peace, Town Clerk, Secretary to a Shire, Electoral Registrar. Post‑master, Classified Officer in the State or Commonwealth Public Service, Classified State School Teacher, or a member of the Police Force.

Form No. 10

Western Australia

Registration of Births, Deaths and Marriages Act 1961

APPLICATION UNDER SECTION 55 TO REGISTER THE BIRTH OF A LEGITIMATED PERSON BORN IN WESTERN AUSTRALIA

To the REGISTRAR GENERAL.

1.I,……………………………………………………………………….…

of…………………………………………………………………………

(usual address)

apply, pursuant to Section 55 of the Registration of Births, Deaths and Marriages Act 1961, for registration of the birth of……………………….

……………………………………………………………………………..

who was born at………………………on…………………………………

(…………………………(parents’

the………………of(full

(son, daughter)(…………………………...names)

and who was by virtue of Section…………………..of the Marriage Act 1961, of the Parliament of the Commonwealth, legitimated by the marriage of the said parents at……………………on……………………..

2.I attach the following documents: — 

(strike out any not applicable)

A.Certified Copy of the registration of birth of……………………….

…………………………………..…………………………………..

B.Certified Copy of the registration of the marriage of the said parents.

C.A prescribed Birth Information Paper duly completed.

D.Other evidence of legitimacy (specify)……………………………

E.An Order made under Section 92 of the Marriage Act 1961, of the Parliament of the Commonwealth.

Date………………………..Signature……………………

FOR OFFICE USE ONLY

Registration No ………………..………………

Receipt No. and Date…………..………………

Entered by and Date………….………………..

Indexed to Year…………….by……………….

Date D.R. Advised…………………………….

Checked by and Date …………………………

Registration of Births, Deaths and Marriges Act 1961

Form No. 11

Section 21A (2)

Regulation 16A

Western Australia

REQUEST BY MOTHER AND FATHER UNDER
SECTION 21A (2) — SURNAME OF CHILD

Please read the Notes at the bottom of the page before completing this form.

We………………………………………………………………………………...

(Full names, addresses and occupations of mother and father)

parents of ………………………………………………………………………...

(Given or first name of the child)

who was born on……………………….at……………………………in Western Australia, request the Registrar General to enter in the register the surname of this child as……………………………………………………………………….

Dated this……………………………day of………………….………., 19……..

at…………………………………………..……………….

Signature of:

Father………………Witness………………………

Address………………………

Mother………………Witness………………………

Address………………………

Note:

(1)This form is only to be completed where it is intended that the child be given a surname different from that of the father.

(2)The surname of a child, if not the same as that of the father may, be — 

(a)the surname of the mother, if the Registrar General is satisfied that she has a surname that is different from the surname of the father; or

(b)the surname of both parents, where the parents have different surnames.

(3)Subject to Sections 21A (3) and (5) which relate to traditional naming by ethnic groups, all children of the same mother and father whose births are registered in Western Australia shall bear the same surname.

Registration of Births, Deaths and Marriages Act 1961

Form No. 12

Section 21A (3)

Regulation 16B

Western Australia

REQUEST UNDER SECTION 21A(3) TO ENTER IN REGISTER A SURNAME GIVEN IN ACCORDANCE WITH A RECOGNISED RELIGIOUS CUSTOM OR NAMING PROCEDURE

Please read the Notes at the bottom of this page before completing this form.

We………………………………………………………………………………...

(Full names, addresses and occupations of mother and father)

parents of…………………………………………………………………………

(Full name of the child)

who was born on…………………………at……………………….in Western Australia, hereby request the Registrar General to enter in the register………….

…………………….as the surname of our child, and hereby declare that — 

1.The surname of ………………………………………………………….

is a name selected in accordance with the recognised religious custom or naming procedure of……………………………………………………….

……………………………………………………………………………..

(Name or description of ethnic group)

2.*Both of us are members of that ethnic group.

* I…………………………………...…am a member of that ethnic group.

(name)

3.We agree to this application.

Dated this……………………………day of………………….………., 19……..

at…………………………………………..……………….

Signature of:

Father………………Witness………………………

Address………………………

Mother………………Witness………………………

Address………………………

Note:

(1)The Registrar General may only enter as the surname of a child a name different from that of his or her parents or from that of other children of the same mother and father whose names are registered in Western Australia if he is satisfied that the use of that surname is in accordance with the recognised religious custom or naming procedure of the ethnic group to which one or both of the parents of the child belong.

(2)The Registrar General may require evidence to support this application.

* Delete whichever is inapplicable.

Registration of Births, Deaths and Marriages Act 1961

Form No. 13

Section 73A

Regulation 16C

Western Australia

APPLICATION UNDER SECTION 73A FOR CHANGE OF SURNAME OF CHILD

Please read the Notes at the bottom of this page before completing this form.

We……………………………………………………………………………….

(Full names, addresses and occupations of mother and father)

parents of…………………………………………………………………………

(Registered name of the child)

who was born on……………………at……………………in Western Australia, apply to the change our child’s surname from……………………………………

(registered surname)

to . . . . . . . . . . . . . . . . . . . . . . and hereby declare that — 

   (proposed surname)

1.The proposed surname is a name selected in accordance with the religious custom or naming procedure of……………………………………………

(name or description of ethnic group)

2.Both of us are members of that ethnic group.

* I……………………………………am a member of that ethnic group.

3.We agree to this application.

Dated this……………………………day of………………….………., 19……..

at…………………………………………..……………….

Signature of:

Father………………Witness………………………

Address………………………

Mother………………Witness………………………

Address………………………

Note:

(1)This form is to be completed where the surname of a child has been entered in a register in Western Australia and the mother and the father wish to substitute a different surname in the register.

(2)Application must be made no later than 6 months after the day set forth in column 3 of the Third Schedule against the relevant ethnic group.

(3)The proposed surname must be in accordance with a recognised religious custom or naming procedure of the ethnic group to which one or both of the parents of the child belong as prescribed by the regulations.

(4)The Registrar General may require evidence to support this application.

* Delete whichever is inapplicable.

[Second Schedule amended by Gazette 10 January 1966 p.58; 24 January 1986 pp.259‑61.]

3rd Schedule

Regulations 16D and 16E

Column 1

Column 2

Column 3

Prescribed Ethnic

Group

Prescribed Religious Custom

or Naming Procedure

Prescribed Day

Christmas and Cocos Islanders

Naming procedure of the followers of Islam.

1 February 1986

 

Given name, indication of gender, father’s given name. e.g. — 

 

 

Male child: Anwar bin Harun

 

 

Given name — Anwar

Gender — bin

Father’s given name — Harun

 

 

Female child: Fatimah binti Harun

Given name — Fatimah

Gender — binti

Father’s given name — Harun

 

[Third Schedule inserted by Gazette 24 January 1986 p.261.]

 

Notes

1.This is a compilation of the Registration of Births, Deaths and Marriages Act Regulations 1963 and includes the amendments referred to in the following Table.

Compilation table

Citation

Gazettal

Commencement

Registration of Births, Deaths and Marriages Act Regulations 1963

29 Aug 1963 pp.2557‑72

29 Aug 1963

 

27 Jun 1980 p.1941

 

 

28 Oct 1983 p.4371

 

 

30 Dec 1983 p.5029

 

 

11 Jan 1985 p.178

 

 

24 Jan 1986 pp.259‑61

1 Feb 1986

 

31 Oct 1986 p.4040

 

 

3 Jul 1987 p.2560

 

 

15 Jul 1988 p.2450

 

 

21 Jul 1989 p.2217

 

 

28 Dec 1990 pp.6369‑70

 

 

2 Aug 1991 p.3993

 

 

23 Jun 1992 p.2634

1 Jul 1992

Registration of Births, Death and Marriages Amendment Regulations 1993

6 Aug 1993 pp.4274‑5

16 Aug 1993

Registration of Births, Deaths and Marriages Amendment Regulations 1994

24 Jun 1994 p.2881

1 Jul 1994

Registration of Births, Deaths and Marriages Amendment Regulations (No. 2) 1994

30 Dec 1994 p.7346

3 Jan 1995

Registration of Births, Deaths and Marriages Amendment Regulations 1997

5 Aug 1997 p.4446

5 Aug 1997

Registration of Births, Deaths and Marriages Amendment Regulations 1998

30 Jun 1998 p.3545 (Correction in Gazette 7 July 1998 p.3619)

30 Jun 1998

These regulations were repealed by the Births, Death and Marriages Registration Act 1998 s. 71(2) (No. 39 of 1998) as at 14 Apr 1999 (see s. 2 and Gazette 9 Apr 1999 p. 1433)