BDM516

 Good character reference for 
independent marriage or civil union 
celebrant applicant

Last updated 7 April 2025 

Two referees are required.

How to answer this form:

• You can complete this form by hand or on-screen using Adobe Acrobat Reader.
• You can use the Tab key to move to the next fillable form field in Adobe Acrobat Reader.
• You must still print off the application and sign by hand.



Section 1: Applicant’s personal details

1. 
Applicant’s name

First and middle names


(Enter first and middle names) 


Surname or family names


(Enter surname or family names) 


2. Applicant’s name at birth (if different from above)

First and middle names at birth


(Enter first and middle names at birth) 


Surname or family names at birth


(Enter surname or family names at birth) 


3. Applicant’s birth details

Date of birth (dd/mm/yyyy)


(Enter date of birth using format dd/mm/yyyy) 


Town or city of birth


(Enter town or city of birth) 


Country of birth (if not New Zealand)


(Enter country of birth) 




Section 2: Good character reference

A person (other than family) over the age of 16 years of age must complete and sign below.

4. 
Referee’s name

First and middle names


(Enter first and middle names) 


Surname or family names


(Enter surname or family names) 


5. How many years have you known the applicant?

Years


(Enter number of years you have known the applicant) 


6. 
Declaration

I declare that the applicant is a person of good character. I fully support their application to be an 
independent celebrant.

Your signature

Date signed (dd/mm/yyyy)


(Enter date using format dd/mm/yyyy) 


7. Referee’s contact details

Contact phone number


(Enter referee's contact phone number) 


Email address


(Enter referee's email address) 


 
Next steps

Print and sign the form.

Applicant to include this form in their application.

 Contact details

Website: govt.nz/bdm/contactus