APPLICATION FOR A BIRTH CERTIFICATE
PLEASE READ THESE NOTES before completing this form.
Birth Certificate
: BIR/134/100
1 TO BE COMPLETED BY THE APPLICANT
Name of applicant Mr
Mrs
Miss/Ms
(STATE NAME IN FULL)
Full postal address
 
Post Code: Telephone no: e-mail address:
2 Are you applying for your own birth certificate? Yes/No
If not please state your relationship to the person:
 
3 DETAILS OF BIRTH CERTIFICATE REQUIRED
FULL NAME AT BIRTH FATHER'S FULL NAME MOTHER'S FULL NAME
FORENAME(S)   FORENAME(S) FORENAME(S)
 
SURNAME   SURNAME  SURNAME 
MAIDEN SURNAME
DATE OF BIRTH PLACE OF BIRTH (Full address or name of hospital)
DAY  MONTH  YEAR
4 REQUIREMENTS Send this Application to:
BIRTH CERTIFICATE £10.00 Superintendent Registrar, Wirral Register Office, Town Hall, Mortimer Street, Birkenhead, CH41 5EU, UK
I requireNUMBER birth certificate(s)
5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)
UK: applications should enclose an SAE. Postal order or cheque made payable to : Wirral Council for £ 10.00
Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Wirral Council
The Fee for a certificate issued against this form 'as printed' will not be refunded.
You are strongly recommended to add any qualifying information you may have in order to help the registrar issue the correct certificate.