Council House, Priory Road, Dudley, West Midlands, DY1 1HF
/

Dudley Registration Service

Request a Copy of a Birth, Death, Marriage

or Civil Partnership Certificate

SAME DAY SERVICE

This form can be used to request any certificate type, using our Same Day certificate service.

We also offer alternative options (at different costs) that enable you to order certificates using our Standard service (normally processed within 2 working days, plus postage time), or Priority one hour service (order by 3pm). If you require either of these options then please use the appropriate form.

Our Same Day service allows you to order one copy of any single certificate for our Same Day Fee, which includes the statutory cost of one certificate and Royal Mail 1st Class recorded and signed for postage. Your request must be received by 12 noon. Applications received after 12pm will be processed on the next working day. Please note that someone must be available to sign for the certificate at the point of delivery.

In all cases, you will need to state the details of the person and the specific certificate type required, and then provide all of the necessary details. Some of the details needed depend on the type of certificate.

Please follow any instructions provided carefully – if you get something wrong then this may delay us in providing a service to you – you can help us by ensuring you provide a daytime telephone number and an email address, so we can contact you if needed.

We recommend that you keep a copy of your completed form for your records.

Ordering a Copy Certificate Online (Same Day Service):
You can upload your completed form and make your debit/credit card payment by using the same link on our Website that you used when you downloaded it.

Please note that all information marked with *must be completed.

Data Protection Statement

Your information will be processed in accordance with Data Protection legal requirements. Please see the Council's Privacy Statement and Charter

Applicant’s (Your) details:*

Name
(Forenames and Surname):
Daytime Telephone:
Email address:
Address:

Type of Certificate Required:

When you use our online service to upload your certificate order you will be asked to indicate the certificate type that you require.

The system will tell you how much the certificate costs, which is currently £25.00.

Type of Certificate / Tick Certificate Type Required
Same Day Service: Birth Certificate
Same Day Service: Marriage Certificate
Same Day Service: Death Certificate
Same Day Service: Civil Partnership Certificate

Once you’ve completed the details (from the next page onwards),follow the instructions on the first page to upload yourcompleted formand to make the necessary payment.

Registration Copy Certificates SAME DAY SERVICE Order Form

General enquiries: 0300 555 2345 Twitter/YouTube: dudleymbc Facebook: DudleyRegisterOffice

Details for the Person and Certificate Type Required

Please note that all information marked with * must be completed / Type of
Certificate:*
Certificate Relates To:*
(Forenames, Surname) / Type of Certificate:*
(please choose one only) / Date of:*
Birth, Death, Marriage, Civil Partnership
(as appropriate) / Dudley Registration Reference No
(if known)
e.g. D/B/ABC/12B / Standard / Short #
(BIRTH only)
Birth
Death
Marriage
Civil Partnership
If not applying for own certificate – please state relationship to person shown:*
Purpose of Certificate:* / E.G. Passport application
Additional Details for the above (continued on the next page)*
Please provide the details requested below based on the Certificate Type that You Require
Birth / Name of Hospital or Address where born
(at least the locality or town) * / Fathers Details
(forenames, surname) * / Mothers Details
(forenames, surname, maiden name)*
Additional Details for the above (continued from previous page)*
Please provide the details requested below based on the Certificate Type that You Require
Death / Place of Death (Address, name of hospital, or locality) * / Home address* / Deceased’s Occupation * / Date of Birth
or age at death *
Marriage / Name of Church, Register Office, approved premises
or locality * / Spouse’s Details
(forenames,surname) * / Surname before marriage / Any other surname used before marriage
Civil Partnership / Name of Register Office,
approved premises
or locality * / Partner’s Details
(forenames,surname and address) * / Surname before partnership / Any other surname used before partnership
Please note: if address at the time of registration for both Partners is not provided then only an extract certificate can be issued.

Registration Copy Certificates SAME DAY SERVICE Order Form

General enquiries: 0300 555 2345 Twitter/YouTube: dudleymbc Facebook: DudleyRegisterOffice