• INDEPENDENT STATE OF PAPUA NEW GUINEA

  • Civil Registration Act (Chapter 304) Amended 2014

  • BIRTH & NATIONAL IDENTITY REGISTRATION FORM

  • *National Identity Card Registration:

  • DD - MM - YYYY

  • A.Child or Applicant's Details:

    PLEASE WRITE IN BLOCK LETTERS & FILL UP ALL REQUIRED INFORMATION (*)

  • DD - MM - YYYY

  • Adoption (Fill Form 4: Particulars of an Adoption)

  • Format: (000) 000-0000.

  • MOTHER

  • *Family Name: (Father's Surname)

  • DD - MM - YYYY

  • DD - MM - YYYY

  • Parents Marriage Information: Type of Marriage:

    (Civil & Customary Marriage Only)

  • DD - MM - YYYY

  • C.National Identity Card Information:

    THIS SECTION IS TO BE COMPLETED BY APPLICANTS 18 YEARS AND ABOVE ONLY

  • Preferred Spouse Family Name: (Married Woman Only)

  • AUTHORIZED WITNESS ONLY - COUNCILLOR, PASTOR, CLAN LEADER, HEALTH WORKER, PROFESSIONALS

  • I hereby certify that the above information is correct for the purpose of registration under the Civil Registration Act (Chapter 304) Amended 2014

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