Order Birth Certificate Please enable JavaScript in your browser to complete this form.If the birth took place overseas you need to order your certificate from that country *This birth occurred in the Cook IslandsDetails of the person who was bornFirst and middle names *At the time of birthSurname or family names *At the time of birthDate of birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of birthPlace of BirthRarotongaAitutakiAtiuMitiaroMaukeMangaiaPalmerstonNassauPukapukaManihikiRakahangaPenrhynOptionalApplying for selfThis is my own birth certificateParent’s details Providing this information may help us to find the birth record.Parent’s first and middle namesFirst and middle names at the time of birthParent’s surname or family namesSurname or family names at the time of birthOther parent’s first and middle namesFirst and middle names at the time of birthOther parent’s surname or family namesSurname or family names at the time of birthYour contact information.This will help us contact you for further verification and when your certificate is ready.Your full name *Valid Email AddressDaytime phone numberOther phone numberSubmit