Birth Certificate Replacement
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Birth Certificate
Surname at birth
*
Forename(s)
*
Date of birth (dd/mm/yyyy)
*
Country of Birth
England or Wales
Scotland
North Ireland
Place of birth
*
Father/parent surname
*
Father/parent forename(s)
*
Mother's maiden surname
*
Mother's forename(s)
*
Your full name (person who orders)
*
Gender
*
Male
Female
Telephone
*
By checking this box, I agree to submit the information provided to this website, and I authorize QuickBirthRecords to use my information to fill all necessary documents in order to find my certificate. I also confirm that all my details are filled in correctly.
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