APPLICATION FOR A BIRTH CERTIFICATE
PLEASE READ THESE NOTES before completing this form.
Birth Certificate
: KNU/29/15
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, Macclesfield Register Office, Town Hall, Market Place, Macclesfield, Cheshire, SK10 1EA, UK
I requireNUMBER birth certificate(s)
5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)
Applications should Postal order or cheque made payable to : Cheshire East Borough Council for £ 10.00 plus postage as follows: within UK £1.00 , within rest of Europe £1.50 , rest of the world £2.00
If paying by Credit Card: Please debit my account by the amount: £ Type of card
(e.g. Visa, Mastercard or Switch):
Name on Card:
 
Card Expiry Date (DD/MON/YYYY):
Enter both Card Number & Security Code. Card Number:                                       Security
Code:
     
Signature:
 
Date:

 

Card Issue No. :
(Switch only)
Card Start Date (DD/MON/YYYY):
(Switch only)
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.