)
OF ADULT
Payment details over the page you MUST return pages 1 and 2 if applying via mail
Identification and Certificate Access Requirements
See page 2 or visit
www.bdm.dotag.wa.gov.auFull name of applicant who has undergone sexual reassignment surgery
Surname
Given name(s)
Address
Residential Postcode
Postal Postcode
Daytime phone
number
Place of birth
Date of birth
Day Month Year
/ /
Sex at Birth Male Female
Fathers full name
Given name(s) Surname
Mothers full name &
maiden surname
Given name(s) Surname Maiden Surname
Has your name been formally changed? Yes No
If yes, attach copy of Change of Name Certificate
Do you wish to formally change your name(s) as a result of the sex change? Yes No
If yes, a separate change of name application must be completed - $156.00 fee applies
I attach the following:
− A recognition Certificate issued under Section 15 of the Gender Reassignment Act
− A registration fee of $44.00
I hereby declare:
− that the information I have provided is true and correct. I understand that the WA Registry of Births, Deaths and
Marriages may make enquiries with any organisation or individual to verify the information provided with this
application;
− the Recognition Certificate was issued more than one month prior to the date of this application;
− that no appeal has been lodged under Section 17(2) of the Gender Reassignment Act,
and I hereby apply to have my birth registration amended to record the change of my sex from:
Male to Female or Female to Male (tick appropriate box)
SIGNATURE OF APPLICANT
Signature must
be completed
OFFICE USE ONLY
LIST 1 (with photo): Drivers Licence Passport Proof of Age Firearms Licence Defence/police DIAC Certificate
ID Ref:
...
LIST 2 : Birth Cert(Aust) Citizenship Cr/Debit Card Health Medicare Centrelink Student card Travel Doc
ID Ref:
...
..
LIST 3 (current address): Bank Statement Rates notice Educational report Motor Vehicle Rego Utility account Rental agreement
ID Ref:
...
If ID provided from Lists 2 and 3, one ID must contain a signature
Other
Initial ID sighted.
....
.....
Fees including standard postal delivery effective 1 July 2009 Subject to change without further notice No GST is payable for this service
Registration Fee $44.00 Includes the issue of a standard birth certificate on completion of the registration process
BDM500
Registry of Births, Deaths and Marriages,
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please fill out the above application and send it in with all monies due
we will get back to you
