Sch 10Statement of reasons

Schedule 10—Statement of reasons

Regulation 18A

Unique donor identifier (if relevant):

I, [name] of [address] am—

 a person born as a result of a donor treatment procedure who is making an application for the disclosure of information recorded on the Central Register; or

 a parent of a person born as a result of a donor treatment procedure who is making an application for the disclosure of information recorded on the Central Register; or

 a person who is descended from a person born as a result of a donor treatment procedure who is making an application for the disclosure of information recorded on the Central Register; or

 a donor who is making an application for the disclosure of information recorded on the Central Register.

This document outlines my reasons for making this application.

Section 1: Reasons for application

[information about your reasons for the application]

Section 2: Information about you

[if relevant, any information that you would like the person about whom you are requesting information to know about you]

[attach any necessary supporting material]

Section 3: Expectations about contact and method of communication

[if you are seeking to make contact with the person about whom you are requesting information, information about—

(a) any expectations you have in relation to communication with the person; and

(b) how you would like to be contacted by the person (for example, by email, phone or in person); and

(c) any other information that you would like the person to know.]

I acknowledge that I have provided this information for the purposes of my application and that this form will be provided to the person about whom I am requesting information with my identifying information redacted.

Signed: [signature of person]

The Donor Conception Registrar manages the Central Register which contains information about donors and persons born as a result of a treatment procedure or artificial insemination using donor gametes. See section 53 of the Assisted Reproductive Treatment Act 2008 (the Act).

A person who is born as a result of a donor treatment procedure may apply to the Donor Conception Registrar under section 56 of the Act for disclosure of information on the Central Register relating to their donor's name, the donor's date of birth and the donor's unique donor identifier.