"Birth Certificate Application Form" - Ontario, Canada

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Download "Birth Certificate Application Form" - Ontario, Canada

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Ontario Birth Certificate Application
This application is to obtain a birth certificate for subjects born in Ontario
Although you can fill out the application online, you cannot save or email it. Please type, print and sign the application then fax, scan
and email or mail your application to us. A receipt, along with your order information, will be issued and sent to you by email or mail.
Is the Subject Deceased?
Yes
No
(if yes, please see “Important Note”)
Important Note: If you are obtaining a birth certificate for someone who is deceased or if you are applying for a child and you are not a
parent listed on the birth registration, please contact the Registrar’s Office at 1-800-461-2156 as additional documentation is required.
Applications are processed upon receipt. As such, we cannot change or cancel applications once received.
Contact Information
Relationship to subject?
*Self
Mother
Father
*Must be at least 13 years old to apply for self
Name: ___________________________________________
Firm/Organization: ___________________________________________
Applicant
Complete only if certificate to be delivered here
Telephone Number:
(_____) ________________________
Extension: ________
Daytime Number:
(_____) ________________________
Extension: ________
Mailing Address: _______________________________________________________
Apt.: ___________ Buzzer Code: ___________
Certificates delivered by courier
City: _________________________ Prov./State: _________________ Country: _________________ Postal/Zip Code: _______________
If Required, I Prefer to be Contacted by:
Email
Telephone
Email Address: __________________________________________________________________________________________________
Receipt will be mailed if no email provided
Application
You must enter as much information as possible. If information is missing or does not match the original birth registration there
may be delays in processing your application. If there has been a legal name change, please use the new legal name.
Reason Required:
First Time Applying
Lost
Stolen
Damaged
Other: _________________________
Please Specify Reason
Subject Name*: __________________________________ _____________________________ _____________________________
First
Middle
Last
*Use the subject’s last name at birth unless there has been a legal name change. Assuming your spouse’s last name is NOT a legal name change.
Subject Gender:
Male
Female
Previous Legal Name: ______________________________ _____________________________ _____________________________
If Applicable
First
Middle
Last
Other
Previous Legal Name: ______________________________ _____________________________ _____________________________
If Applicable
First
Middle
Last
Date of Birth: ________________ ___________ ___________
Place of Birth: _________________________________, ONTARIO
Month
Day
Year
City/Town
Weight at Birth: ______________ ___________ ___________
Number of Older Siblings at Time of Birth: __________
Pounds
Ounces
OR
Grams
Print Form
Ontario Birth Certificate Application
This application is to obtain a birth certificate for subjects born in Ontario
Although you can fill out the application online, you cannot save or email it. Please type, print and sign the application then fax, scan
and email or mail your application to us. A receipt, along with your order information, will be issued and sent to you by email or mail.
Is the Subject Deceased?
Yes
No
(if yes, please see “Important Note”)
Important Note: If you are obtaining a birth certificate for someone who is deceased or if you are applying for a child and you are not a
parent listed on the birth registration, please contact the Registrar’s Office at 1-800-461-2156 as additional documentation is required.
Applications are processed upon receipt. As such, we cannot change or cancel applications once received.
Contact Information
Relationship to subject?
*Self
Mother
Father
*Must be at least 13 years old to apply for self
Name: ___________________________________________
Firm/Organization: ___________________________________________
Applicant
Complete only if certificate to be delivered here
Telephone Number:
(_____) ________________________
Extension: ________
Daytime Number:
(_____) ________________________
Extension: ________
Mailing Address: _______________________________________________________
Apt.: ___________ Buzzer Code: ___________
Certificates delivered by courier
City: _________________________ Prov./State: _________________ Country: _________________ Postal/Zip Code: _______________
If Required, I Prefer to be Contacted by:
Email
Telephone
Email Address: __________________________________________________________________________________________________
Receipt will be mailed if no email provided
Application
You must enter as much information as possible. If information is missing or does not match the original birth registration there
may be delays in processing your application. If there has been a legal name change, please use the new legal name.
Reason Required:
First Time Applying
Lost
Stolen
Damaged
Other: _________________________
Please Specify Reason
Subject Name*: __________________________________ _____________________________ _____________________________
First
Middle
Last
*Use the subject’s last name at birth unless there has been a legal name change. Assuming your spouse’s last name is NOT a legal name change.
Subject Gender:
Male
Female
Previous Legal Name: ______________________________ _____________________________ _____________________________
If Applicable
First
Middle
Last
Other
Previous Legal Name: ______________________________ _____________________________ _____________________________
If Applicable
First
Middle
Last
Date of Birth: ________________ ___________ ___________
Place of Birth: _________________________________, ONTARIO
Month
Day
Year
City/Town
Weight at Birth: ______________ ___________ ___________
Number of Older Siblings at Time of Birth: __________
Pounds
Ounces
OR
Grams
Application - continued
Where Birth Occurred:
Hospital: __________________________________________
Home
Birthing Centre
Name
Other:
__________________________________________
Please Specify
Who Delivered Subject:
Physician
Midwife
Other
Unknown
Name of Doctor/Attendant
: _______________________________________________________________________
(at time of subject’s birth)
Address of Doctor/Attendant: _______________________________________________________________________________________
Mother’s Name: _______________________________
_______________________________
_______________________________
First
Middle
Last (Maiden name)
Other Last Name(s) Used by Mother: _________________________________________________________________________________
Mother’s Address: _______________________________________________________ Apt.: ___________ Buzzer Code: ___________
Address at time of subject’s birth
City: _________________________ Prov./State: _________________ Country: _________________ Postal/Zip Code: _______________
Mother’s Marital Status
:
Single
Married
Divorced
Widowed
Common Law
(at time of subject’s birth)
:
Mother’s Age
: __________
Mother’s Date of Birth
_______________
___________
___________
(at time of subject’s birth)
Month
Day
Year
Mother’s Place of Birth:
City/Town: _________________________ Prov./State: _________________ Country: ________________
Father’s Name: _______________________________
_______________________________
_______________________________
First
Middle
Last
:
Father’s Age
: __________
Father’s Date of Birth
_______________
___________
___________
(at time of subject’s birth)
Month
Day
Year
Father’s Place of Birth:
City/Town: _________________________ Prov./State: _________________ Country: ________________
Guarantor -
This section must be completed for subjects aged 9 or older.
Guarantors must be known by the applicant (name shown on Contact Information) for at least two years, reside in Canada, be a Canadian
citizen, hold an occupation from the list below, is not retired, and is a practicing member in good standing. You must have permission by
the guarantor to provide his or her information. The guarantor can be a family member, provided they hold an occupation from the list
below. The guarantor does not need to sign the application.
The following are guarantors for the purposes of section 45.1 of the Vital Statistics Act: Chief of a band recognized under the Indian
Act (Canada), chiropractor, dentist, First Nations police officer, judge, justice of the peace, lawyer, mayor, member of the Legislative
Assembly of Ontario (MPP), midwife, minister of religion authorized under provincial law to perform marriages, municipal clerk or
treasurer (a member of the Association of Municipal Managers, Clerks and Treasurers of Ontario), notary public, nurse, optometrist,
pharmacist, physician, police officer (municipal, provincial, RCMP), principal or vice-principal (primary or secondary school), professional
accountant, professional engineer, psychologist, senior administrator (community college or in a CEGEP), senior administrator or professor
in a university, signing officer of a bank, caisse d'économie, caisse populaire, credit union or trust company social worker or social service
worker, surgeon, teacher in a primary or secondary school or Veterinarian.
Name: ____________________________
____________________________
Occupation: ________________________________
First
Last
Must be an occupation listed above
Organization/Firm (if applicable): ______________________________________
Registration #: ______________________________
If available or applicable
Work Address: _____________________________________________________
Unit/Suite: _______ City: _____________________
Province: __________________________
Postal Code: ___________________
Daytime Phone Number: (______) _____________________ Extension:
_______e
Fax Number: (______) _______________________
Payment Information
No more than one short form (wallet size) and one long form (certified copy) will be issued by the Government of Ontario. All delivery
times quoted are average delivery times, and cannot be guaranteed. All taxes and shipping costs are included.
Short Form (wallet size) – First time applying for Birth Certificate – 15 to 20 business days - $75.00
Short Form (wallet size) – Replacement Birth Certificate – 15 to 20 business days - $85.00
Short Form (wallet size) – Rush – First time applying for Birth Certificate – 5 to 7 business days – $110.00
Short Form (wallet size) – Rush – Replacement Birth Certificate – 5 to 7 business days – $120.00
Long Form (certified copy) – First time applying for Certified Copy – 15 to 20 business days – $85.00
Long Form (certified copy) – Replacement Certified Copy – 15 to 20 business days – $95.00
Long Form (certified copy) – Rush – First time applying for Certified Copy – 5 to 7 business days – $120.00
Long Form (certified copy) – Rush – Replacement Certified Copy – 5 to 7 business days – $130.00
Newborns: A certificate will be issued upon completion of the birth registration. The registration takes approximately 16 weeks
from the date of birth. Rush service is not available for newborns born within the last 16 weeks. Please contact the Registrar’s Office
at 1-800-461-2156 if you do require a certificate for a newborn on a rush basis.
Births Prior to 1930: Births prior to 1930, may not be in electronic format. When applying for a birth certificate for a birth prior to
1930, it can take up to an extra 6-8 weeks for the registration to be converted into electronic format before processing can be completed.
Births Over 95 Years Ago: The Province of Ontario retains birth records for 95 years. If you require a birth certificate for a birth that oc-
curred over 95 years ago, please contact Archives of Ontario at 1-800-668-9933.
Delivery Outside Canada: Rush service is not available for delivery outside of Canada.
Credit Card Type:
(or)
Phone me for credit card details (cardholder must still sign below).
Credit Card Number: _____________________________________________ Exp. Date: ___________
Name of Cardholder: _____________________________________________ Cardholder Email: _________________________________
Date: ____________________________ Signature: _______________________________________
Charge will appear as “Express Legal” on credit card statement.
If paying by money order or certified cheque please mail the completed application along with your payment.
Any applications received with a personal cheque will be held until such time as the cheque clears, typically 7 days.
Cheques and money orders must be made payable to “Express Legal”.
Birth Certificate Authorization
By signing below, you are authorizing Express Legal to request a Certificate of Birth. Your certificate will be sent to you directly from the
Ontario Office of the Registrar General. Applications without a signature will not be processed.
Name: _____________________________________________________________________________
Type / Print Name
Date:
____________________________ Signature: _______________________________________
Applicant
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