APPLICATION FOR A BIRTH CERTIFICATE
PLEASE READ THESE NOTES before completing this form.
Birth Certificate
Leeds : HUNS/174/335
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 Hunslet
4 REQUIREMENTS Send this Application to:
BIRTH CERTIFICATE £10.00 Superintendent Registrar, Leeds Register Office, 2 Great George Street, Leeds, LS2 8BA
I requireNUMBER birth certificate(s)
5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)
UK: applications should enclose a Postal order or cheque made payable to : Superintendent Registrar for £ 12.00
If applying by phone please ring our Contact centre on 0113 2224408 and provide your credit/debit card details to the Customer services officer.

Overseas: applications should enclose payment by Bankers Sterling Draft payable to : Superintendent Registrar
If applying by phone please ring our Contact centre on +44 113 2224408 and provide your credit/debit card details to the Customer services officer.
Please note that due to financial security reasons we are unable to accept applications containing credit/debit card details by post.
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.