Statutory Declaration of Acknowledgement of Parentage Form

Signature
of
Declarant
THIS DECLARATION MUST BE MADE BEFORE A JUSTICE OF THE PEACE, MAGISTRATE,
COMMISSIONER FOR OATHS, PRACTISING SOLICITOR, NOTARY PUBLIC, LICENSED CONVEYANCER,
AUTHORISED ADVOCATE OR AUTHORISED LITIGATOR, BY ONE PARENT ONLY.
STATUTORY DECLARATION OF ACKNOWLEDGEMENT OF PARENTAGE
required for the purposes of the
Births and Deaths Registration Act 1953, Sections 10 and 10A
I, (your full name) .....................................................................................................................................................................................
of (address) ...............................................................................................................................................................................................
do hereby solemnly and sincerely declare that I am the mother/father/parent* of the (sex of child) .....................................................
child born to me/(full name of child's mother) .........................................................................................................................................
on the (date of child's birth in words) .......................................................................................................................................................
at (precise place of child's birth)...............................................................................................................................................................
and that I/(full name of child's father/parent*) ......................................................................................... am/is the child's father/parent*
And I make this solemn Declaration conscientiously believing the same to be true, and by virtue of the
provisions of The Statutory Declarations Act 1835.
Declared by the said ...................................................................................
......................................................................................................................
at ...................................................................................................................
this ............................................................................................................ day of
................................................................................................... Two Thousand
and ................................................................................................................ ...................................................................................................
before me
Signature .....................................................................................................
Name ............................................................................................................
Designation .................................................................................................
(JP, Magistrate etc)
Address ........................................................................................................
......................................................................................................................
Form 16
* "Parent" means the mother's female partner who under the Human Fertilisation and Embryology Act 2008 is to be treated as a
parent of the child.
(delete as appropriate)
(SEE
OVER)
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