PLEASE NOTE

THIS APPLICATION FORM

MUST BE COMPLETED IN FULL
BIRTH CERTIFICATE
POSTAL APPLICATION FORM

TODAYS DATE:

YOUR FULL NAME: ..

POSTAL ADDRESS: ..

POST CODE: TEL NO: ......
Are you applying for your own birth certificate? (PLEASE TICK BOX) YES NO
If not please state your relationship to the person
to whom the certificate relates

.....
Please state for what the purpose the certificate is
required?

.....
If the person has ever been legally adopted DO NOT complete this form but ask Barnsley Registration
Service for the relevant application form
DETAILS OF BIRTH CERTIFICATE REQUIRED
Cheque/Postal Order for 10.00 enclosed
(made payable to Barnsley MBC)
Yes No

NAMES GIVEN AT BIRTH
FIRST NAME(S)



SURNAME
DATE OF BIRTH



PLACE OF BIRTH




MOTHERS NAME


FATHERS NAME



MOTHERS MAIDEN SURNAME



FOR OFFICIAL USE ONLY

REGISTER NO.:



ENTRY/PAGE NO.:


CERTIFICATE NO.:



DATE COMPLETED: